Healthcare Provider Details

I. General information

NPI: 1932994332
Provider Name (Legal Business Name): DERM LOUNGE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 W KATELLA AVE
ANAHEIM CA
92804-6450
US

IV. Provider business mailing address

113 WATERWORKS WAY STE 210
IRVINE CA
92618-3176
US

V. Phone/Fax

Practice location:
  • Phone: 714-798-2900
  • Fax:
Mailing address:
  • Phone: 714-798-2900
  • Fax: 949-216-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HARRIS C KHAN
Title or Position: PRESIDENT
Credential:
Phone: 714-458-6668