Provider Demographics
NPI:1508401761
Name:AHMAD BEACH SKIN MD INC
Entity Type:Organization
Organization Name:AHMAD BEACH SKIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-366-1216
Mailing Address - Street 1:320 SUPERIOR AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2778
Mailing Address - Country:US
Mailing Address - Phone:949-333-9056
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE STE 260
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2778
Practice Address - Country:US
Practice Address - Phone:949-333-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty