Fountain of Youth Cosmetic Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

A30411 Issued in CA

Legal business name

FOUNTAIN OF YOUTH COSMETIC CENTER

Practice address

17100 Norwalk Blvd Ste 111
Cerritos, CA 90703-2750

Phone

(562) 653-0180

Fax

(562) 402-3029

NPI assigned

Sep 16, 2009

Last updated

Sep 16, 2009By 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

Anil K Gandhi, M.D.NPI 1972824753

Title

Owner

Phone

(562) 653-0180

Specialties & licenses 1

Addresses

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.

• Anil Krishnakumar Gandhi, M.D.

  • Surgery Physician
  • Cerritos, CA
  • NPI 1972824753
  Authorized official Same address or phone

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

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253059200000",
    "number": "1821321209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 NORWALK BLVD STE 111",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032750",
            "telephone_number": "562-653-0180",
            "fax_number": "562-402-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 NORWALK BLVD STE 111",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032750",
            "telephone_number": "562-653-0180",
            "fax_number": "562-402-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF YOUTH COSMETIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A",
        "authorized_official_last_name": "GANDHI",
        "authorized_official_first_name": "ANIL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-653-0180",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A30411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garrett Flowers
• Brian Matthew Fong
• Kelly Fong
• Jacqueline Claire Fontenot
• John Ford, M.D.
• Precious Fragozo
• Michael Franc, PSYD
• Francisco Badar MD Inc (Core Healthcare Group)
• Emmanuel Franco
• Katerin Franco

• Specialist in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; 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.