Advanced Skin Clinic & Surgery, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ADVANCED SKIN CLINIC & SURGERY, PC

Practice address

1310 San Bernardino Rd
Suite 207
Upland, CA 91786-4979

Phone

(909) 946-8600

Fax

(909) 946-8604

NPI assigned

Dec 8, 2010

Last updated

Aug 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tan Nguyen, MDNPI 1144273491

Title

Owner

Phone

(909) 946-8600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FABCBA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tan Khac Nguyen, M.D.

  • Procedural Dermatology Physician
  • Upland, CA
  • NPI 1144273491
  Medicare reassignment Care Compare group Authorized official
• Tamuyen Nguyen, M.D.

  • Dermatology Physician
  • Upland, CA
  • NPI 1710041686
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312761600000",
    "number": "1194028423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD",
            "address_2": "SUITE 207",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864979",
            "telephone_number": "909-946-8600",
            "fax_number": "909-946-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD",
            "address_2": "SUITE 207",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864979",
            "telephone_number": "909-946-8600",
            "fax_number": "909-946-8604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SKIN CLINIC & SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-08",
        "last_updated": "2011-08-08",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-946-8600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Upland, CA
• Providers in Upland, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.