Ak Derm Corp

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

AK DERM CORP

Practice address

16030 Ventura Blvd Ste 100
Encino, CA 91436-2754

Phone

(949) 412-6011

NPI assigned

Mar 11, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ava Khosraviani, MDNPI 1578717401

Title

President

Phone

(949) 412-6011

Specialties & licenses 1

Addresses

Other names 1

• skinwell dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ava Khosraviani, M.D.

  • Dermatology Physician
  • Burbank, CA
  • NPI 1578717401
  Medicare reassignment Care Compare group NPD Authorized official
• Stacey Pun, MD

  • Dermatopathology (Pathology) Physician
  • Los Angeles, CA
  • NPI 1851763783

  Dermatology

  Medicare reassignment Care Compare group NPD
• Soheil Simzar, M.D.

  • Dermatology Physician
  • Santa Monica, CA
  • NPI 1780881797
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552262400000",
    "number": "1013475805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15526 AQUA VERDE DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 VENTURA BLVD STE 100",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362754",
            "telephone_number": "949-412-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AK DERM CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2019-03-11",
        "status": "A",
        "authorized_official_last_name": "KHOSRAVIANI",
        "authorized_official_first_name": "AVA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-412-6011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "skinwell dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aim Home Care Inc West la
• Dennis Ainbinder, M.D.
• David Harlan Aizuss, M.D.
• Aj Physical Therapy Inc
• Aj PT West Inc
• Terry Akhtarzad, MA
• Basmah Akhter
• Yeside Obiajulu Akinyemi, M.D.
• Akm Medical Group
• Svetlana Akopian

• Dermatology Physician in Encino, CA
• Providers in Encino, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.