Provider Demographics
NPI:1528606654
Name:EVEREST MEDSPA LLC
Entity Type:Organization
Organization Name:EVEREST MEDSPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIAOBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-413-9406
Mailing Address - Street 1:6787 MARKET ST STE 106
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1848
Mailing Address - Country:US
Mailing Address - Phone:610-413-9406
Mailing Address - Fax:
Practice Address - Street 1:6787 MARKET ST STE 106
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1848
Practice Address - Country:US
Practice Address - Phone:610-413-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty