Healthcare Provider Details

I. General information

NPI: 1508753278
Provider Name (Legal Business Name): CHELSEA FIDAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

IV. Provider business mailing address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-6075
  • Fax:
Mailing address:
  • Phone: 310-927-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHELSEA FIDAI
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 310-927-6075