Organization
ELEGANT SKIN CARE MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT M KELLY D.O. (OWNER/CEO)
(818) 955-9550
Entity
Organization
Contact information
Practice address
1117 N HOLLYWOOD WAY, B, BURBANK, CA 91505-2528
(818) 955-9550
(818) 955-9507
Mailing address
1117 N HOLLYWOOD WAY, B, BURBANK, CA 91505-2528
(818) 955-9550
(818) 955-9507
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20A8453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A8453
CERTIFICATE
CA
Enumeration date
08/02/2006
Last updated
08/22/2020
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