Provider Demographics
NPI:1942225255
Name:CENTER FOR FACIAL APPEARANCE, PC
Entity Type:Organization
Organization Name:CENTER FOR FACIAL APPEARANCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:801-363-3355
Mailing Address - Street 1:1002 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-4505
Mailing Address - Country:US
Mailing Address - Phone:801-363-3355
Mailing Address - Fax:801-533-9613
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:877-844-3223
Practice Address - Fax:801-533-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty