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

Last updated

Sep 11, 2012By 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

Dr. Louis David Potyondy, M.D.NPI 1104884956

Title

Managing Member

Phone

(229) 589-2588

Specialties & licenses 1

Addresses

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 2

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.

• Louis David Potyondy, M.D.

  • Plastic Surgery Physician
  • Tacoma, WA
  • NPI 1104884956
  Authorized official Same address or phone
• 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": [],
    "endpoints": [],
    "other_names": []
}

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• 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.