Organization
DERMATOLOGY & LASER MEDICAL CTR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEX A KHADAVI M.D. (OWNER)
(818) 528-2500
Entity
Organization
Contact information
Practice address
16260 VENTURA BLVD, SUITE 140, ENCINO, CA 91436-2203
(818) 528-2500
(818) 528-2505
Mailing address
PO BOX 261430, ENCINO, CA 91426-1430
(661) 575-0003
(661) 575-0006
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
A71517
CA
207ND0900X
Dermatopathology Physician
A71517
CA
207NS0135X
Procedural Dermatology Physician
Primary
A71517
CA
Other
Enumeration date
10/07/2008
Last updated
07/18/2011
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