Advanced Dermatology Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A92449 Issued in CA

Legal business name

ADVANCED DERMATOLOGY INC.

Doing business as

Advanced Dermatology of San Clemente Inc

Practice address

34213 Pacific Coast Hwy
Dana Point, CA 92629

Phone

(949) 248-4547

Fax

(949) 248-4587

NPI assigned

Oct 17, 2006

Last updated

Jun 27, 2019By 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

Dr. Maryam Moinfar, MDNPI 1376515403

Title

President

Phone

(952) 240-2827

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dermatology of San Clemente Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Maryam Moinfar, MD

  • Dermatology Physician
  • Dana Point, CA
  • NPI 1376515403
  Medicare reassignment Care Compare group NPD Authorized official
• Jeffrey Keith Lander, M.D., PH.D.

  • Dermatology Physician
  • Irvine, CA
  • NPI 1174566046
  Medicare reassignment Care Compare group NPD
• Bijan Haghighi, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Orange, CA
  • NPI 1790868909
  Medicare reassignment NPD
• Shylie Falahatimarvast, PA-C

  • Physician Assistant
  • Dana Point, CA
  • NPI 1861271603
  Medicare reassignment
• Madeline Grace McClure Fee, PA-C

  • Physician Assistant
  • Dana Point, CA
  • NPI 1528780988
  Medicare reassignment
• Jay Gerard Tassin, M.D.

  • Therapeutic Radiology Physician
  • San Clemente, CA
  • NPI 1659787596
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1336220540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34213 PACIFIC COAST HWY",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926292875",
            "telephone_number": "952-240-2827",
            "fax_number": "949-248-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34213 PACIFIC COAST HWY",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "92629",
            "telephone_number": "949-248-4547",
            "fax_number": "949-248-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "MOINFAR",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-240-2827",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A92449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology of San Clemente Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Dermatology of San Clemente Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.