Healthcare Provider Details

I. General information

NPI: 1831650548
Provider Name (Legal Business Name): JUSTIN WU MARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 BRISTOL ST STE 650
COSTA MESA CA
92626-7311
US

IV. Provider business mailing address

3080 BRISTOL ST STE 650
COSTA MESA CA
92626-7311
US

V. Phone/Fax

Practice location:
  • Phone: 949-317-2558
  • Fax: 213-408-4414
Mailing address:
  • Phone: 949-317-2558
  • Fax: 213-408-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number201566
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number306483
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number201566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: