| NPI | 1730445313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE ROBERT SONG Owner / Principal 949-701-4454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A102406) |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2015-04-08 |