Basic Information
| Provider Information | |||||||||
| NPI: | 1255923595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MODERN AESTHETIC INSTITUTE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2029 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933032029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055655700 | ||||||||
| FaxNumber: | 6613357766 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 TRUXTUN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933090743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055655700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2021 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8055655700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0200X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.