Provider Demographics
NPI:1205348141
Name:KP AESTHETICS, LLC.
Entity type:Organization
Organization Name:KP AESTHETICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-420-4094
Mailing Address - Street 1:4675 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2227
Mailing Address - Country:US
Mailing Address - Phone:484-420-4094
Mailing Address - Fax:
Practice Address - Street 1:4675 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2227
Practice Address - Country:US
Practice Address - Phone:484-420-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty