Provider Demographics
NPI:1801138946
Name:SKY FACIAL PLASTIC SURGERY, INC
Entity type:Organization
Organization Name:SKY FACIAL PLASTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRIUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-381-4801
Mailing Address - Street 1:16918 DOVE CANYON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3445
Mailing Address - Country:US
Mailing Address - Phone:858-381-4801
Mailing Address - Fax:
Practice Address - Street 1:16918 DOVE CANYON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3445
Practice Address - Country:US
Practice Address - Phone:858-381-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty