NPIMap

Organization Active NPI

East Bay Dermatology Medical Group Inc

Doing business as Center for Dermatology Cosmetic & Laser Surgery

  • Dermatology Physician
  • Fremont, CA
National Provider Identifier
1447220215
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EAST BAY DERMATOLOGY MEDICAL GROUP INC
Doing business as
Center for Dermatology Cosmetic & Laser Surgery
Practice address
2557 Mowry Ave Ste 25
Fremont, CA 94538-1614
Phone
(510) 797-4111
Fax
(510) 797-3320
NPI assigned
Jan 25, 2006
Last updated
Jul 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Authorized official

Name
Sunil S Dhawan, MDNPI 1326018987
Title
Owner
Phone
(510) 797-4112

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

2557 Mowry Ave Ste 25
Fremont, CA 94538-1614

Mailing address

2557 Mowry Ave Ste 25
Fremont, CA 94538-1614
Phone (510) 797-4111

Other names 1

  • Center for Dermatology Cosmetic & Laser Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090115000065 CA Part B Supplier - Clinic/Group Practice 2466515580 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Fremont, CA; Milpitas, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
05D0598729East Bay Dermatology Medical Group, Inc2557 Mowry Ave, Ste 25, Fremont, CA 94538ComplianceAug 15, 2026

National Provider Directory

National Provider Directory

Locations

995 Montague Expy
Ste 111
Milpitas, CA 95035
Phone (408) 957-7676

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1447220215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 MOWRY AVE STE 25",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381614",
            "telephone_number": "510-797-4111",
            "fax_number": "510-797-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2557 MOWRY AVE STE 25",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381614",
            "telephone_number": "510-797-4111",
            "fax_number": "510-797-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY DERMATOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "DHAWAN",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-797-4112",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Dermatology Cosmetic & Laser Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; 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.