Provider Demographics
NPI:1396845673
Name:NIKKO COSMETIC SURGERY CENTER
Entity Type:Organization
Organization Name:NIKKO COSMETIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PHAN
Authorized Official - Last Name:NIKKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-960-1311
Mailing Address - Street 1:4707 EIGEL ST.
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3417
Mailing Address - Country:US
Mailing Address - Phone:713-960-1311
Mailing Address - Fax:713-960-1325
Practice Address - Street 1:4707 EIGEL ST.
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3417
Practice Address - Country:US
Practice Address - Phone:713-960-1311
Practice Address - Fax:713-960-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00378RMedicare ID - Type Unspecified