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General NPI Number Information
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NPI Number | 1881947935
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Entity Type | Organization
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Legal Business Name | HAIR AESTHETIC INSTITUTE INC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 11500 W OLYMPIC BLVD SUITE 315
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City | LOS ANGELES
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State | CA
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Zip | 90064-1524
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Country | US
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Telephone | 310-479-4247
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Fax | 310-479-4241
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Provider Business Mailing Address
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Address Line | 11500 W OLYMPIC BLVD SUITE 315
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City | LOS ANGELES
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State | CA
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Zip | 90064-1524
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Country | US
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Telephone | 310-479-4247
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Fax | 310-479-4241
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH DAVID SIPORIN
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Credential | M.D., F.A.C.S.
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Telephone | 310-479-4247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G70646
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License Number State | CA
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