Healthcare Provider Details

I. General information

NPI: 1245145804
Provider Name (Legal Business Name): LA LASER CENTER PC, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 W AVENUE K STE 100
LANCASTER CA
93534-5925
US

IV. Provider business mailing address

PO BOX 16297
BEVERLY HILLS CA
90209-2297
US

V. Phone/Fax

Practice location:
  • Phone: 661-567-0950
  • Fax:
Mailing address:
  • Phone: 888-993-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL TAHERI
Title or Position: CEO
Credential:
Phone: 310-922-1412