NPIMap

Organization Active NPI

Shanthimd Dermatology, Inc.

  • Dermatology Physician
  • Los Angeles, CA
National Provider Identifier
1245698752
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A123314 Issued in CA
Legal business name
SHANTHIMD DERMATOLOGY, INC.
Practice address
2990 S Sepulveda Blvd
Suite 300
Los Angeles, CA 90064-0002
Phone
(323) 421-4747
Fax
(949) 955-7351
NPI assigned
Jan 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Mrs. Shanthi Marie Colaco, MDNPI 1144482167
Title
Ceo/Owner
Phone
(323) 421-4747

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
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X A123314 CA Primary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X A123314 CA

Addresses

Primary practice location

2990 S Sepulveda Blvd
Suite 300
Los Angeles, CA 90064-0002

Mailing address

2990 S Sepulveda Blvd
Suite 300
Los Angeles, CA 90064-0002
Phone (323) 421-4747

Other names 1

  • ShanthiMD Dermatology, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160309001766 CA Part B Supplier - Clinic/Group Practice 4486950987 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

2990 S Sepulveda Blvd
Ste 300
Los Angeles, CA 90064
Phone (323) 421-4747

Practitioners & affiliated clinicians

Practitioners 2

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": "1454025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1245698752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 S SEPULVEDA BLVD",
            "address_2": "SUITE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900640002",
            "telephone_number": "323-421-4747",
            "fax_number": "949-955-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 S SEPULVEDA BLVD",
            "address_2": "SUITE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900640002",
            "telephone_number": "323-421-4747",
            "fax_number": "949-955-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANTHIMD DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-29",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "COLACO",
        "authorized_official_first_name": "SHANTHI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "323-421-4747",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A123314",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A123314",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShanthiMD Dermatology, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.