Organization
KIMIKO AND TEDESCO LLC
Active
Organization
KIMIKO AND TEDESCO LLC
Active
Other names
Kimiko Medical Aesthetics, Green Country Surgical Arts
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BREANN H TEDESCO (OFFICE MANAGER)
(918) 600-0026
Entity
Organization
Contact information
Practice address
11911 S OXFORD AVE STE 200, TULSA, OK 74137-7778
(918) 600-0026
(918) 600-0690
Mailing address
11911 S OXFORD AVE STE 200, TULSA, OK 74137-7778
(918) 600-0026
(918) 600-0690
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790951747
COMMUNITY CARE
OK
05
—
1790951747
—
OK
Enumeration date
01/20/2022
Last updated
09/09/2025
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