Aesthetica Clinique LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

MD 60288108 Issued in WA

Legal business name

AESTHETICA CLINIQUE LLC

Practice address

801 Pacific Ave
Tacoma, WA 98402-5209

Phone

(229) 589-2588

NPI assigned

May 2, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Louis David Potyondy, M.D.

Title

Managing Member

Phone

(229) 589-2588

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amirali Shakouripartovi, MD

  • Surgery Physician
  • Tacoma, WA
  • NPI 1013563741
  NPD

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1508824293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025209",
            "telephone_number": "229-589-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025209",
            "telephone_number": "229-589-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETICA CLINIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "POTYONDY",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "229-589-2588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "WA",
            "license": "MD 60288108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "569370029A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOCTORS'S NPI",
            "identifier": "1104884956",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Advanced Pain Medicine Physicians, PLLC
• Advanced Physical Therapy & Balance Rehabilitation LLC
• Advanced Proliance Homecare and Staffing LLC
• Advanced Womens Health
• Advent Senior Care Home LLC
• Judy Jisoo Aeum, M.D.
• Affable Palace Afh LLC
• Affiliated Radiology, LLC
• Affirming Connections Therapy PLLC
• Briana Marie Affonso

• Plastic Surgery Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Plastic Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.