KIMIKO AND TEDESCO LLC – NPI #1396497319
Dermatology

Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).

KIMIKO AND TEDESCO LLC is a dermatologist located in TULSA, OK. NPPES has assigned the NPI number 1396497319 to KIMIKO AND TEDESCO LLC on January 20, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. This provider is also associated with 2 additional names listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207NS0135X from the Health Care Provider Taxonomy code set, which is classified as Dermatology, specializing in Procedural Dermatology

The NPI profile was last updated on Sep 09, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for KIMIKO AND TEDESCO LLC below.

NPI Profile for
KIMIKO AND TEDESCO LLC

NPI Number
1396497319
Enumeration Date

(more than 4 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
KIMIKO AND TEDESCO LLC
Other name(s)
All associated names:
Doing Business As (dba)
Green Country Surgical Arts
Former Legal Business Name
Kimiko Medical Aesthetics
Primary location
11911 S OXFORD AVE STE 200
TULSA, OK 74137-7778
Phone: (918) 600-0026 Fax: (918) 600-0690
1 Other location(s):
5555 E 71st Street
Suite 7255
Tulsa, OK 74136
Phone: (918) 600-0026
Fax: (918) 600-0024
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
BREANN TEDESCO
OFFICE MANAGER
Phone: (918) 600-0026
Updated
Certification Date
Sep 09, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for KIMIKO AND TEDESCO LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
otherAETNAOK1790951747
otherBLUE CROSS BLUE SHIELDOK1790951747
otherCIGNAOK1790951747
otherCOMMUNITY CAREOK1790951747
otherGLOBAL HEALTHOK1790951747
otherHEALTH CHOICEOK1790951747
otherPHCSOK1790951747
otherPREFERED COMMUNITY CHOICEOK1790951747
otherUNITED HEALTHCAREOK1790951747
otherVAOK1790951747
medicaidOK1790951747
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.