Organization
FAIRMONT DERMATOLOGY MEDICAL ASSOCIATES INC
Active
Parent organization
FAIRMONT DERMATLOGY MEDICAL ASSOCIATES INC
Other names
Abdallah Khourdaji
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIRMONT DERMATLOGY MEDICAL ASSOCIATES INC
Authorized official
DR. ABDALLAH KHOURDAJI MD (PRESIDENT)
(209) 333-6110
Entity
Organization
Contact information
Practice address
801 S HAM LN STE A, LODI, CA 95242-7502
(209) 333-6110
(209) 333-0724
Mailing address
801 S HAM LN STE A, LODI, CA 95242-7502
(209) 333-6110
(209) 333-0724
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
00A341430
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A341430
LEGACY ID#
CA
Enumeration date
05/01/2008
Last updated
06/13/2008
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