Provider Demographics
NPI:1922864743
Name:SF BAY AREA PLASTIC SURGERY MEDICAL GROUP
Entity Type:Organization
Organization Name:SF BAY AREA PLASTIC SURGERY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZILAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-964-2200
Mailing Address - Street 1:515 SOUTH DR STE 25
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4209
Mailing Address - Country:US
Mailing Address - Phone:650-964-2200
Mailing Address - Fax:650-964-2205
Practice Address - Street 1:515 SOUTH DR STE 25
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4209
Practice Address - Country:US
Practice Address - Phone:650-964-2200
Practice Address - Fax:650-964-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty