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General NPI Number Information
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NPI Number | 1598772337
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Entity Type | Organization
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Legal Business Name | ELEGANT SKIN CARE MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1117 N HOLLYWOOD WAY B
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City | BURBANK
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State | CA
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Zip | 91505-2528
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Country | US
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Telephone | 818-955-9550
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Fax | 818-955-9507
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Provider Business Mailing Address
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Address Line | 1117 N HOLLYWOOD WAY B
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City | BURBANK
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State | CA
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Zip | 91505-2528
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Country | US
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Telephone | 818-955-9550
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Fax | 818-955-9507
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. ALBERT M KELLY
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Credential | D.O.
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Telephone | 818-955-9550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A8453
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License Number State | CA
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