Provider Demographics
NPI:1598204943
Name:AESTHETX
Entity Type:Organization
Organization Name:AESTHETX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAKSHI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-559-7177
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-559-7177
Mailing Address - Fax:408-559-7199
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-559-7177
Practice Address - Fax:408-559-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty