San Diego Dermatology and Cosmetic Surgery Medical Group, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G83901 Issued in CA

Legal business name

SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC.

Practice address

6367 Alvarado CT
Suite 107
San Diego, CA 92120-4904

Phone

(619) 287-1882

Fax

(619) 287-4121

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Fred F Shahan, M.D., PHARM.D.NPI 1811913221

Title

President

Phone

(619) 287-1882

Specialties & licenses 1

Addresses

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

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)…

Practitioners 9

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

• Fred F Shahan, MD

  • Dermatology Physician
  • San Diego, CA
  • NPI 1811913221
  Medicare reassignment NPD Authorized official
• Daniel J Marnell, MD

  • Dermatology Physician
  • San Diego, CA
  • NPI 1508831280
  Medicare reassignment NPD
• Michelle Ann Cote, PAC

  • Medical Physician Assistant
  • San Diego, CA
  • NPI 1659554715
  Medicare reassignment
• Diana Truc Dang, MD

  • Dermatology Physician
  • El Centro, CA
  • NPI 1194736074
  NPD
• Anthony Vu Huynh, MD

  • Dermatology Physician
  • El Centro, CA
  • NPI 1497766364
  NPD
• Nhi Nguyen

  • Physician Assistant
  • El Centro, CA
  • NPI 1922884303
  NPD
• Jayme Lynn Storms, N.P.

  • Family Nurse Practitioner
  • El Centro, CA
  • NPI 1083078547
  NPD
• Persephonie Anastasia Tweten

  • Physician Assistant
  • Pomona, CA
  • NPI 1629591250
  NPD
• Robert Lee Stephenson, M.D.

  • Internal Medicine Physician
  • Encinitas, CA
  • NPI 1386642478
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1447334396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6367 ALVARADO CT",
            "address_2": "SUITE 107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921204904",
            "telephone_number": "619-287-1882",
            "fax_number": "619-287-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6367 ALVARADO CT",
            "address_2": "SUITE 107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921204904",
            "telephone_number": "619-287-1882",
            "fax_number": "619-287-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO DERMATOLOGY AND COSMETIC SURGERY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "SHAHAN",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-287-1882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PHARM.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G83901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.