Provider Demographics
NPI:1720230840
Name:WAVE PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:WAVE PLASTIC SURGERY CENTER
Other - Org Name:WAVE PLASTIC SURGERY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-383-4800
Mailing Address - Street 1:3680 WILSHIRE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2709
Mailing Address - Country:US
Mailing Address - Phone:213-383-4800
Mailing Address - Fax:213-674-2827
Practice Address - Street 1:3680 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2709
Practice Address - Country:US
Practice Address - Phone:213-383-4800
Practice Address - Fax:213-674-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84673284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital