Eternal Youth Medical Spa

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

ETERNAL YOUTH MEDICAL SPA

Doing business as

Mark A.F. Knight, M.D.

Practice address

902 N. Grand Avenue
Suite 204
Santa Ana, CA 92701

Phone

(714) 558-9800

Fax

(714) 558-9803

NPI assigned

Oct 10, 2018

Organization subpart

Yes

Parent organization

ETERNAL YOUTH MED SPAAs reported in NPPES

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

Authorized official

Name

Mrs. Maria Jett Knight

Title

Office Director

Phone

(714) 558-9800

Specialties & licenses 1

Addresses

Other names 1

• Mark A.F. Knight, M.D. Doing business as

Part of

Eternal Youth Medical Spa

Locations

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1649745274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 N. GRAND AVENUE",
            "address_2": "SUITE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92701",
            "telephone_number": "714-558-9800",
            "fax_number": "714-558-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N. GRAND AVENUE",
            "address_2": "SUITE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92701",
            "telephone_number": "714-558-9800",
            "fax_number": "714-558-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETERNAL YOUTH MEDICAL SPA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ETERNAL YOUTH MED SPA",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "JETT",
        "authorized_official_title_or_position": "OFFICE DIRECTOR",
        "authorized_official_telephone_number": "714-558-9800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark A.F. Knight, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Plastic and Reconstructive Surgery Physician in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.