Provider Demographics
NPI:1952666216
Name:ADVANCED AESTHETICS & INTEGRATED MEDICAL CENTER
Entity Type:Organization
Organization Name:ADVANCED AESTHETICS & INTEGRATED MEDICAL CENTER
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SACHDEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-636-2550
Mailing Address - Street 1:121 C AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2353
Mailing Address - Country:US
Mailing Address - Phone:503-636-2550
Mailing Address - Fax:503-636-3544
Practice Address - Street 1:121 C AVE
Practice Address - Street 2:121 C AVE
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2353
Practice Address - Country:US
Practice Address - Phone:503-636-2550
Practice Address - Fax:503-636-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X
OR305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service