Kimiko and Tedesco LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

KIMIKO AND TEDESCO LLC

Doing business as

Green Country Surgical Arts

Practice address

11911 S Oxford Ave Ste 200
Tulsa, OK 74137-7778

Phone

(918) 600-0026

Fax

(918) 600-0690

NPI assigned

Jan 20, 2022

Last updated

Sep 9, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Breann H Tedesco

Title

Office Manager

Phone

(918) 600-0026

Specialties & licenses 3

Addresses

Other identifiers 11

Other names 2

• Green Country Surgical Arts Doing business as
• Kimiko Medical Aesthetics Former legal business name

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Victor Tedesco, D.O.

  • Plastic and Reconstructive Surgery Physician
  • Tulsa, OK
  • NPI 1790951747

  Multi-Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757376000000",
    "number": "1396497319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11911 S OXFORD AVE STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377778",
            "telephone_number": "918-600-0026",
            "fax_number": "918-600-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11911 S OXFORD AVE STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377778",
            "telephone_number": "918-600-0026",
            "fax_number": "918-600-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMIKO AND TEDESCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A",
        "authorized_official_last_name": "TEDESCO",
        "authorized_official_first_name": "BREANN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-600-0026",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERED COMMUNITY CHOICE",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CHOICE",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GLOBAL HEALTH",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CARE",
            "identifier": "1790951747",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "1790951747",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Country Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kimiko Medical Aesthetics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sharon K. Kimberlin, PA-C
• Matthew T Kimberling, MD
• Jennifer L Kimbrel, PA-C
• Ebony Kimbrough
• Camryn Kime
• Demita Glynne Kinard
• Rose Marie Kinard, RN
• Courtney Dyan Kincaid, MSW
• Kelsey Kincaid
• Bridget Kincanon, SLP

• Procedural Dermatology Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Procedural Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.