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General NPI Number Information
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NPI Number | 1669977021
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Entity Type | Organization
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Legal Business Name | SHONAN BEAUTY CLINIC BEVERLY HILLS, INC.
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 425 HAALAND DRIVE SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-5229
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Country | US
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Telephone | 805-723-8008
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Fax | 805-852-2675
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Provider Business Mailing Address
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Address Line | 425 HAALAND DRIVE SUITE 102
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-5229
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Country | US
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Telephone | 805-723-8008
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Fax | 805-852-2675
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAMES PAUL WATSON
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Credential | M.D.
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Telephone | 805-723-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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