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General NPI Number Information
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NPI Number | 1942225255
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Entity Type | Organization
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Legal Business Name | CENTER FOR FACIAL APPEARANCE, PC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 WILSHIRE BLVD SUITE 301
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 877-844-3223
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Fax | 801-533-9613
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Provider Business Mailing Address
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Address Line | 1002 E SOUTH TEMPLE SUITE 308
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-4505
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Country | US
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Telephone | 801-363-3355
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Fax | 801-533-9613
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOHN D MCCANN
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Credential | MD, PHD
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Telephone | 801-363-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A51131
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License Number State | CA
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