MEDICARE: DR JASON PLASTIC SURGERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1487588315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JASON PLASTIC SURGERY INC

Provider Business Mailing Address
First Line	:	9675 BRIGHTON WAY STE 350
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5188
Country	:	US
Telephone Number	:	909-710-2020
Fax Number	:	909-710-2021

Provider Business Practice Location Address
First Line	:	9675 BRIGHTON WAY STE 350
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5188
Country	:	US
Telephone Number	:	909-710-2020
Fax Number	:	909-710-2021

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	STEVUNI KAY HARRISON
Credential	:
Telephone Number	:	909-710-2020

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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