| NPI | 1326299496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX A KHADAVI Owner 818-528-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: CA A71517) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A71517) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA A71517) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2011-07-18 |