Provider Demographics
NPI:1114246907
Name:BELLAVITA CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY, CORP.
Entity Type:Organization
Organization Name:BELLAVITA CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY, CORP.
Other - Org Name:BELLAVITA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FU-TSUN
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-275-1114
Mailing Address - Street 1:416 N BEDFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4308
Mailing Address - Country:US
Mailing Address - Phone:310-275-1114
Mailing Address - Fax:310-275-1157
Practice Address - Street 1:416 N BEDFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4308
Practice Address - Country:US
Practice Address - Phone:310-275-1114
Practice Address - Fax:310-275-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11134208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty