# ANTI AGING SURGICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245466192
- **Authorized official:** SHANIN MOSHIRI (MEDICAL DIRECTOR/OWN)
- **Authorized official phone:** (773) 284-9660

## Contact information

- **Practice address:** 3918 W 63RD ST, CHICAGO, IL 60629-4604
- **Practice address phone:** (773) 284-9660
- **Mailing address:** PO BOX 11232, CHICAGO, IL 60611
- **Mailing address phone:** (773) 284-9660
- **Mailing address fax:** (773) 284-9676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 60011238 | IL | Yes |

## Other

- **Enumeration date:** 06/05/2009
- **Last updated:** 08/06/2015