NPIMap

Organization Active NPI

Dermatology & Laser Medical Ctr Inc

  • Procedural Dermatology Physician
  • Encino, CA
National Provider Identifier
1326299496
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
A71517 Issued in CA
Legal business name
DERMATOLOGY & LASER MEDICAL CTR INC
Practice address
16260 Ventura Blvd
Suite 140
Encino, CA 91436-2203
Phone
(818) 528-2500
Fax
(818) 528-2505
NPI assigned
Oct 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Authorized official

Name
Dr. Alex A Khadavi, M.D.
Title
Owner
Phone
(818) 528-2500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X A71517 CA
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X A71517 CA
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X A71517 CA Primary

Addresses

Primary practice location

16260 Ventura Blvd
Suite 140
Encino, CA 91436-2203

Mailing address

PO Box 261430
Encino, CA 91426-1430
Phone (661) 575-0003

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1326299496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261430",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914261430",
            "telephone_number": "661-575-0003",
            "fax_number": "661-575-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16260 VENTURA BLVD",
            "address_2": "SUITE 140",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362203",
            "telephone_number": "818-528-2500",
            "fax_number": "818-528-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & LASER MEDICAL CTR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "KHADAVI",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-528-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A71517",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "A71517",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A71517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.