Provider Demographics
NPI:1114198975
Name:KARL D. BASSLER, M.D, INC
Entity Type:Organization
Organization Name:KARL D. BASSLER, M.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-855-3376
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:# 520
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-855-3376
Mailing Address - Fax:949-609-1971
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:# 520
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-855-3376
Practice Address - Fax:949-609-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64015207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH17881OtherUPIN #
CAP00230697OtherRAILROAD MEDICARE PIN #
CADD4828OtherRAILROAD MEDICARE GROUP #
CAA64015OtherSTATE LICENSE #
CABB5695486OtherDEA #
CAP00230697OtherRAILROAD MEDICARE PIN #