Derma Glow Med Spa Corp

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

DERMA GLOW MED SPA CORP

Practice address

22237 Lorain Rd
Fairview Park, OH 44126-3315

Phone

(440) 641-1406

NPI assigned

Jun 20, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nina Kazemi Shojayi, MD

Title

Medical Director

Phone

(440) 641-1406

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719705600000",
    "number": "1043054497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22237 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263315",
            "telephone_number": "440-641-1406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22237 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263315",
            "telephone_number": "440-641-1406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMA GLOW MED SPA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-30",
        "certification_date": "2024-06-30",
        "status": "A",
        "authorized_official_last_name": "SHOJAYI",
        "authorized_official_first_name": "NINA",
        "authorized_official_middle_name": "KAZEMI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "440-641-1406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Fairview Park, OH
• Providers in Fairview Park, OH by specialty
• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.