Provider Demographics
NPI:1578971230
Name:SSK PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:SSK PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHROOZ
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:KELISHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-395-2266
Mailing Address - Street 1:21163 NEWPORT COAST DR # 132
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1123
Mailing Address - Country:US
Mailing Address - Phone:949-395-2266
Mailing Address - Fax:
Practice Address - Street 1:500 SUPERIOR AVE
Practice Address - Street 2:340
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3657
Practice Address - Country:US
Practice Address - Phone:949-515-7874
Practice Address - Fax:949-650-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty