East Bay Dermatology Medical Group Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G53340 Issued in CA

Legal business name

EAST BAY DERMATOLOGY MEDICAL GROUP INC.

Practice address

1158 Jacklin Rd
Milpitas, CA 95035-3700

Phone

(408) 957-7676

Fax

(408) 942-1342

NPI assigned

Oct 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sunil S. Dhawan, M.D.NPI 1326018987

Title

Secretary of the Corporation

Phone

(408) 957-7676

Specialties & licenses 1

Addresses

Other names 1

• Center For Dermatology Cosmetic and Laser Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• East Bay Dermatology Medical Group Inc

  • Dermatology Physician
  • Fremont, CA
  • NPI 1447220215

  O20090115000065

  Same enrollment

Locations

Practitioners 8

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

• Sunil S Dhawan, MD

  • Dermatology Physician
  • Fremont, CA
  • NPI 1326018987
  NPD Authorized official
• Erik Stephen Cabral, M.D.

  • MOHS-Micrographic Surgery Physician
  • Ukiah, CA
  • NPI 1023252350
  NPD
• Andrea Marie Caro, PA

  • Physician Assistant
  • Fremont, CA
  • NPI 1700602810
  NPD
• Shurong Chang, M.D., PH.D.

  • Dermatology Physician
  • Sacramento, CA
  • NPI 1770873804
  NPD
• Jaspreet Gahunia

  • Family Nurse Practitioner
  • Milpitas, CA
  • NPI 1891516332
  NPD
• Olivia Danielle Martinez, FP-C

  • Family Nurse Practitioner
  • Fremont, CA
  • NPI 1629490362
  NPD
• Tiffany Lam Nguyen, PA-C

  • Physician Assistant
  • Fremont, CA
  • NPI 1932832714
  NPD
• Brittany West, PA-C

  • Medical Physician Assistant
  • Olympia, WA
  • NPI 1568973931
  NPD

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1467640284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 MOWRY AVE STE 34",
            "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": "1158 JACKLIN RD",
            "city": "MILPITAS",
            "state": "CA",
            "postal_code": "950353700",
            "telephone_number": "408-957-7676",
            "fax_number": "408-942-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY DERMATOLOGY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "DHAWAN",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "SECRETARY OF THE CORPORATION",
        "authorized_official_telephone_number": "408-957-7676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G53340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center For Dermatology Cosmetic and Laser Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Duyfaithhoangle Chiropractic, LLC
• Dynamic Communication Speech Therapy Inc.
• Dzu Nguyen Chiropractic Inc
• Early Light Pharmacy LLC
• Early Light Pharmacy LLC
• Chona Minas Ebalo-Villanueva, D.M.D.
• Ec Acupuncture and Wellness Center
• Amanda Eddy
• Howard Edelman, DDS
• Edmond de St Georges DDS Inc

• Specialist in Milpitas, CA
• Providers in Milpitas, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.