Provider Demographics
NPI:1477696276
Name:AESTHETIC DERMATOLOGY LASER CENTER
Entity Type:Organization
Organization Name:AESTHETIC DERMATOLOGY LASER CENTER
Other - Org Name:EDWARD M. KRAMER, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-360-4400
Mailing Address - Street 1:3055 W ORANGE AVE
Mailing Address - Street 2:#207
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3159
Mailing Address - Country:US
Mailing Address - Phone:714-229-8246
Mailing Address - Fax:714-229-9362
Practice Address - Street 1:27995 GREENFIELD DR
Practice Address - Street 2:#C
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4432
Practice Address - Country:US
Practice Address - Phone:949-360-4400
Practice Address - Fax:949-360-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15261AMedicare PIN
CAA53299Medicare UPIN