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General NPI Number Information
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NPI Number | 1972302560
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Entity Type | Organization
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Legal Business Name | NEW WAVE DERMATOLOGY AND LASER
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 5010 CAMPUS DR # 140
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2120
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Country | US
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Telephone | 949-395-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 CAMPUS DR # 140
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2120
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Country | US
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Telephone | 949-395-6221
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Fax |
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Authorized Official
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Title or Position | OWNER CEO
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Name | BOBAK HEDAYATI
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Credential | MD
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Telephone | 949-395-6221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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