Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fairmont Dermatology Medical Associates Inc

Organization Dermatology Physician · NPI 1477729291

Fairmont Dermatology Medical Associates Inc is a Dermatology Physician in Lodi, California. Licensed in California. Registered with an NPI since 2008.

Licensed in
CA
In the registry since
2008
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

801 S Ham Ln Ste A
Lodi, CA 95242-7502
Phone: (209) 333-6110
Fax: (209) 333-0724
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 00A341430 (CA)

Record details

NPI number1477729291
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationFairmont Dermatlogy Medical Associates Inc
Authorized official Abdallah Khourdaji — President · (209) 333-6110
Other names Abdallah Khourdaji
NPI enumeratedMay 1, 2008
Last updated in NPPESJune 13, 2008
Mailing address801 S Ham Ln Ste A, Lodi, CA 95242-7502

Other providers in Lodi