Provider Demographics
NPI:1073984621
Name:SAWAN SURGICAL AESTHETICS PLLC
Entity Type:Organization
Organization Name:SAWAN SURGICAL AESTHETICS PLLC
Other - Org Name:SAWAN INSTITUTE FOR AESTHETIC PLASTIC SURGERY PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PLASTIC SURGEON / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-788-0785
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0029
Mailing Address - Country:US
Mailing Address - Phone:405-788-0785
Mailing Address - Fax:
Practice Address - Street 1:209 LILAC DRIVE
Practice Address - Street 2:# 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-788-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23616208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty