HEAVENLY PLASTIC SURGERY, PC (NPI# 1639651011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639651011 |
| Entity Type | Organization |
| Organization Name | HEAVENLY PLASTIC SURGERY, PC |
| Practice Address |
29300 Portola Pkwy Lake Forest CA 92630-8718 |
| Practice Telephone | 6573335497 |
| Mailing Telephone | 6573335497 |
| Enumeration Date | 2018-09-03 |
| Last Update Date | 2018-09-03 |
| Authorized Official Name | DAVID NGUYEN (CEO) |
| Authorized Official Telephone | 3109803715 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
29300 PORTOLA PKWY |
| City | LAKE FOREST |
| State | CA |
| Zip Code | 92630-8718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700831971 | Richard R Moy | Podiatrist | 29300 Portola Pkwy, Suite B, Lake Forest, CA 92630-8718 | 2006-05-24 |
| 1144588161 | David Nguyen | Surgery | 29300 Portola Pkwy, Lake Forest, CA 92630 | 2012-04-27 |
| 1700103223 | Portola Anesthesia Services LLC | Clinic/Center | 29300 Portola Pkwy, Suite B, Lake Forest, CA 92630-8718 | 2010-04-23 |
| 1104985910 | Foothill Surgical Institute, LLC | Clinic/Center | 29300 Portola Pkwy, Suite A, Lake Forest, CA 92630-8718 | 2006-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194370338 | Ashlee Nicole-morton Sourapas | Midwife | 22672 Lambert Street, Suite 611, Lake Forest, CA 92630 | 2019-08-05 |
| 1134784879 | Scott Mach Enterprises | Custodial Care Facility | 23235 Cavanaugh Road, Lake Forest, CA 92630 | 2019-05-08 |
| 1992368930 | James Daniel Ticorat | Pharmacist | 25051 Calle Arenal, Lake Forest, CA 92630 | 2019-04-16 |
| 1770058349 | Tara L Anderson | Physician Assistant | 22365 El Toro Rd Unit 310, Lake Forest, CA 92630 | 2018-10-10 |
| 1659846855 | Song W. Jung. Dds. Inc | Dentist | 23361 El Toro Rd, Ste 105, Lake Forest, CA 92630 | 2018-10-04 |
| 1326520867 | Katherine Marie Billings | Speech-Language Pathologist | 25454 Navajo, Lake Forest, CA 92630 | 2018-08-31 |
| 1205339611 | Orange County Physiotherapy Services, P.C. | Physical Therapist | 22821 Aspan St., #100, Lake Forest, CA 92630 | 2018-03-12 |
| 1295245587 | Tara Rasta | Chiropractor | 22672 Lambert St Suite 620, Olsen Chiropractic, Lake Forest, CA 92630 | 2017-10-02 |
| 1750800132 | Jessica Aguilar | Marriage & Family Therapist | 21153 Calle De Paseo, Lake Forest, CA 92630 | 2017-09-16 |
| 1275072589 | Anhtu Wu | Pharmacist | 23182 Vista Way, Lake Forest, CA 92630 | 2017-02-20 |
| Find all providers in zip 92630 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144588161 | David Nguyen | Surgery | 29300 Portola Pkwy, Lake Forest, CA 92630 | 2012-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382523 | Beverly Hills Outpatient Surgery Center Inc | Surgery | 50 N La Cienega Blvd Ste 203, Beverly Hills, CA 90211-2246 | 2020-09-24 |
| 1558907857 | California Surgical and Anesthesia Services, Inc | Surgery | 3500 S Bristol St Ste 203, Santa Ana, CA 92704-7306 | 2019-11-21 |
| 1710533864 | Elite Transformations, A Professional Medical Corporation | Surgery | 1795 El Camino Real Ste 200, Palo Alto, CA 94306-1165 | 2019-08-14 |
| 1326503632 | Andre P. Marshall, Md Inc | Surgery | 32456 Crown Valley Pkwy Apt 105, Dana Point, CA 92629-3312 | 2019-01-31 |
| 1598245474 | Jenny Marie Hullinger | Surgery | 711 4th Ave Ste 200, San Diego, CA 92101-6863 | 2018-08-20 |
| 1497249817 | Alexander Villicana Md LLC | Surgery | 624 W Duarte Rd Ste 201, Arcadia, CA 91007-9261 | 2018-06-19 |
| 1316431273 | Justin E. West, Md Inc. | Surgery | 230 S Main St Ste 210, Orange, CA 92868-3851 | 2018-06-14 |
| 1811430234 | Marc Hamilton Hedrick | Surgery | 3020 Callan Rd, San Diego, CA 92121-1109 | 2016-12-02 |
| 1285082859 | Daniel Suissa | Surgery | 9201 W Sunset Blvd Ste 708, West Hollywood, CA 90069-3708 | 2016-05-24 |
| 1780030478 | Eric Yu Kit Li | Surgery | 10430 S De Anza Blvd Ste 170, Cupertino, CA 95014-3000 | 2016-05-11 |
| Find all providers with the same taxonomy | ||||
| City | LAKE FOREST |
| Zip Code | 92630 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.