Provider Demographics
NPI:1982828554
Name:HEAD& NECK MEDICAL & FACIAL PLASTIC SURGERY, INC
Entity Type:Organization
Organization Name:HEAD& NECK MEDICAL & FACIAL PLASTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATNIJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-650-8882
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:SUITE 329
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-650-8882
Mailing Address - Fax:949-650-2293
Practice Address - Street 1:361 HOSPITAL ROAD
Practice Address - Street 2:SUITE 329
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3524
Practice Address - Country:US
Practice Address - Phone:949-650-8882
Practice Address - Fax:949-650-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25477174400000X
CAA89307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A254770Medicaid
CA00A254771Medicaid
CA00A254770Medicaid