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General NPI Number Information
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NPI Number | 1114971975
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY CARE CENTER INC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 19582 BEACH BLVD SUITE 217
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5923
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Country | US
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Telephone | 949-650-1244
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Fax | 949-650-1515
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Provider Business Mailing Address
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Address Line | 19582 BEACH BLVD SUITE 217
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5923
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Country | US
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Telephone | 949-650-1244
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Fax | 949-650-1515
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH SEDRAK
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Credential | MD
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Telephone | 346-888-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G86476
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License Number State | CA
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