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General NPI Number Information
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NPI Number | 1730772955
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Entity Type | Organization
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Legal Business Name | REJUVA MEDICAL AESTHETICS, INC.
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 11645 WILSHIRE BLVD STE 605
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City | LOS ANGELES
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State | CA
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Zip | 90025-6842
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Country | US
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Telephone | 424-644-2400
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Fax | 424-298-4175
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Provider Business Mailing Address
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Address Line | 11645 WILSHIRE BLVD STE 605
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City | LOS ANGELES
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State | CA
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Zip | 90025-6842
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Country | US
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Telephone | 424-644-2400
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Fax | 424-298-4175
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | KIAN KARIMI
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Credential | MD, FACS
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Telephone | 424-644-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) 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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License Number State |
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