NPIMap

Organization Active NPI

Dermacraft Inc

  • Wound Care Registered Nurse
  • Glendale, CA
National Provider Identifier
1881577781
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
DERMACRAFT INC
Practice address
237 N Central Ave Ste a
Glendale, CA 91203-3526
Phone
(818) 807-0530
NPI assigned
Jul 28, 2025
Last updated
Aug 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Authorized official

Name
Khris Kakosimidi
Title
Cfo
Phone
(818) 807-0530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X Primary

Addresses

Primary practice location

237 N Central Ave Ste a
Glendale, CA 91203-3526

Mailing address

237 N Central Ave Ste a
Glendale, CA 91203-3526
Phone (818) 807-0530

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251021002082 CA Part B Supplier - Clinic/Group Practice 9830687086 Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Locations

237 N Central Ave
Ste A
Glendale, CA 91203
Phone (661) 360-6300

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754438400000",
    "number": "1881577781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 N CENTRAL AVE STE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912033526",
            "telephone_number": "818-807-0530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 N CENTRAL AVE STE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912033526",
            "telephone_number": "818-807-0530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMACRAFT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "KAKOSIMIDI",
        "authorized_official_first_name": "KHRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "818-807-0530"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.