ANTI AGING SURGICAL CENTER NPI 1245466192

NPI Information

  • NPI: 1245466192
  • Provider Name: ANTI AGING SURGICAL CENTER
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 14D2155699
  • Address: 3918 W 63RD ST
    CHICAGO, IL
    ZIP 60629
  • Phone: (773) 284-9660

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NPI Details

ANTI AGING SURGICAL CENTER is an ambulatory surgical clinic center in Chicago, IL. ANTI AGING SURGICAL CENTER NPI is 1245466192. The provider is registered as an organization entity type.

The provider's business location address is:

3918 W 63RD ST
CHICAGO, IL
ZIP 60629-604
Phone: (773) 284-9660

The provider's authorized official is Shanin Moshiri .
The authorized official title is Medical Director/own and has the following contact phone number (773) 284-9660.

The CLIA number assigned to this NPI record is 14D2155699 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/5/2009 and was last updated on 8/6/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory Surgical60011238ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========OTHERILLINOISPRIVATE INSURANCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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