Provider Demographics
NPI:1073346789
Name:BODYBY ULTIMATE LLC
Entity type:Organization
Organization Name:BODYBY ULTIMATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HYDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKADAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-336-1511
Mailing Address - Street 1:2777 PACIFIC AVE SUITE I
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-336-1511
Mailing Address - Fax:562-336-1510
Practice Address - Street 1:2777 PACIFIC AVE SUITE I
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-336-1511
Practice Address - Fax:562-336-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty