Organization
CALIFORNIA EYE AND FACIAL PLASTIC SURGERY
Active
Parent organization
CALIFORNIA EYE AND FACIAL PLASTIC SURGERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
CALIFORNIA EYE AND FACIAL PLASTIC SURGERY
Authorized official
JUSTIN JOHNSEN MD (OWNER)
(801) 699-5945
Entity
Organization
Contact information
Practice address
1812 PORT ABBEY PL, NEWPORT BEACH, CA 92660-5310
(801) 699-5945
Mailing address
1812 PORT ABBEY PL, NEWPORT BEACH, CA 92660-5310
(801) 699-5945
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042000760
DEPARTMENT OF FINANCIAL AND PROFRESSIONAL REGULATION
IL
Enumeration date
07/22/2009
Last updated
01/17/2019
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