NPIMap

Organization Active NPI

Foothill Dermatology Medical Center

  • Specialist
  • Glendora, CA
National Provider Identifier
1154592368
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A73248 Issued in CA
Legal business name
FOOTHILL DERMATOLOGY MEDICAL CENTER
Practice address
2301 E Foothill Blvd
Ste 100
Glendora, CA 91740-4000
Phone
(626) 852-3376
Fax
(626) 852-3375
NPI assigned
Mar 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. Amarpaul S Sidhu, M.D.,NPI 1396713822
Title
Owner
Phone
(626) 852-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A73248 CA Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X A73218 CA

Addresses

Primary practice location

2301 E Foothill Blvd
Ste 100
Glendora, CA 91740-4000

Mailing address

2301 E Foothill Blvd
Ste 100
Glendora, CA 91740-4000
Phone (626) 852-3376

Other practice location 1

10470 Foothill Blvd Ste 127
Rancho Cucamonga, CA 91730-3754
Phone (626) 852-3376

Other identifiers 1

IdentifierTypeStateIssuer
00A732480MedicaidCA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1027742Foothill Dermatology Medical Center2301 E Foothill Blvd Ste 100, Glendora, CA 91740ComplianceAug 28, 2027

National Provider Directory

National Provider Directory

Locations

2301 E Foothill Blvd
Ste 100
Glendora, CA 91740
Phone (626) 852-3376

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1154592368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 E FOOTHILL BLVD",
            "address_2": "STE 100",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404000",
            "telephone_number": "626-852-3376",
            "fax_number": "626-852-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 E FOOTHILL BLVD",
            "address_2": "STE 100",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404000",
            "telephone_number": "626-852-3376",
            "fax_number": "626-852-3375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10470 Foothill Blvd Ste 127",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303754",
            "country_code": "US",
            "telephone_number": "626-852-3376",
            "fax_number": "909-483-3108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOOTHILL DERMATOLOGY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SIDHU",
        "authorized_official_first_name": "AMARPAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-852-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A73248",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A73218",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A732480",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.