Provider Demographics
NPI:1184780363
Name:JL PLASTIC SURGERY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JL PLASTIC SURGERY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-626-8420
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1203
Mailing Address - Country:US
Mailing Address - Phone:818-626-8420
Mailing Address - Fax:866-414-0020
Practice Address - Street 1:11550 INDIAN HILLS RD STE 310
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1203
Practice Address - Country:US
Practice Address - Phone:818-626-8420
Practice Address - Fax:866-414-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty