Provider Demographics
NPI:1083922066
Name:EYE FACE & BODY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:EYE FACE & BODY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:YP
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-967-7834
Mailing Address - Street 1:2449 S KING RD
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1811
Mailing Address - Country:US
Mailing Address - Phone:408-238-1978
Mailing Address - Fax:
Practice Address - Street 1:4906 EL CAMINO REAL
Practice Address - Street 2:SUITE C
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1449
Practice Address - Country:US
Practice Address - Phone:650-967-7834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical