Provider Demographics
NPI:1669977021
Name:SHONAN BEAUTY CLINIC BEVERLY HILLS, INC.
Entity type:Organization
Organization Name:SHONAN BEAUTY CLINIC BEVERLY HILLS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-723-8008
Mailing Address - Street 1:425 HAALAND DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5229
Mailing Address - Country:US
Mailing Address - Phone:805-723-8008
Mailing Address - Fax:805-852-2675
Practice Address - Street 1:425 HAALAND DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5229
Practice Address - Country:US
Practice Address - Phone:805-723-8008
Practice Address - Fax:805-852-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty