Healthcare Provider Details

I. General information

NPI: 1922903194
Provider Name (Legal Business Name): ADVANCED SKIN & WOUND SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14331 EUCLID ST STE 204
GARDEN GROVE CA
92843-6509
US

IV. Provider business mailing address

14331 EUCLID ST STE 204
GARDEN GROVE CA
92843-6509
US

V. Phone/Fax

Practice location:
  • Phone: 630-808-5123
  • Fax:
Mailing address:
  • Phone: 630-808-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAZA MEHDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-808-5123