Provider Demographics
NPI:1326249814
Name:PRECISION PLASTIC SURGERY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PRECISION PLASTIC SURGERY, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-854-6777
Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2227
Mailing Address - Country:US
Mailing Address - Phone:310-854-6777
Mailing Address - Fax:
Practice Address - Street 1:50 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2227
Practice Address - Country:US
Practice Address - Phone:310-854-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA944772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI69256Medicare UPIN
CAW20450Medicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER
CAI26543Medicare UPIN