=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689711244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED SKINCARE MEDCENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 369 SAN MIGUEL DR STE 235
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-706-2887
-----------------------------------------------------
Fax | 949-706-2846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 369 SAN MIGUEL DR STE 235
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-706-2887
-----------------------------------------------------
Fax | 949-706-2846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER ALICE ARMSTRONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-706-2887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ND0101X
-----------------------------------------------------
Taxonomy Name | MOHS-Micrographic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------