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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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