| NPI | 1235269473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX A KHADAVI Owner 818-528-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A71517) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A71517) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2015-12-01 |