Organization
AK DERM CORP
Active
Other names
skinwell dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AVA KHOSRAVIANI MD (PRESIDENT)
(949) 412-6011
Entity
Organization
Contact information
Practice address
16030 VENTURA BLVD STE 100, ENCINO, CA 91436-2754
(949) 412-6011
Mailing address
15526 AQUA VERDE DR, LOS ANGELES, CA 90077-1504
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
03/11/2019
Last updated
03/11/2019
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