El Segundo Dermatology, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

EL SEGUNDO DERMATOLOGY, INC.

Practice address

713 N Douglas St.
El Segundo, CA 90245

Phone

(310) 906-2788

Fax

(310) 906-2786

NPI assigned

Jul 17, 2015

Organization subpart

No

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

Authorized official

Name

Brenda Fellman

Title

Practice Manager

Phone

(310) 906-2788

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gardena Dermatology 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 14

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

• Melissa Camouse, D.O.

  • Dermatology Physician
  • Torrance, CA
  • NPI 1689885279
  Medicare reassignment NPD
• Jill Holly Javahery, M.D.

  • Specialist
  • Long Beach, CA
  • NPI 1568647022
  Medicare reassignment NPD
• Malcolm Ke, MD

  • Dermatology Physician
  • Torrance, CA
  • NPI 1245269984
  Medicare reassignment NPD
• Ashley Fowler Magovern, M.D.

  • Dermatology Physician
  • Manhattan Beach, CA
  • NPI 1770761207
  Medicare reassignment NPD
• Ardeshir Edward Nadimi, M.D.

  • MOHS-Micrographic Surgery Physician
  • Los Angeles, CA
  • NPI 1992190417
  Medicare reassignment NPD
• Courtney Phillips, M.D.

  • Dermatology Physician
  • Los Angeles, CA
  • NPI 1215370960
  Medicare reassignment NPD
• Lauren Rae Bennett, PA-C

  • Physician Assistant
  • El Segundo, CA
  • NPI 1245830181
  NPD
• Eve M Katzen, PA-C

  • Physician Assistant
  • Studio City, CA
  • NPI 1053439562
  NPD
• Shamila Shanmugam, PA-C

  • Physician Assistant
  • El Segundo, CA
  • NPI 1417576380
  NPD
• Merrick Adam Brodsky, MD

  • MOHS-Micrographic Surgery Physician
  • Long Beach, CA
  • NPI 1609300649
  NPD (past)
• Keerthi R De Silva, M.D.

  • Specialist
  • Gardena, CA
  • NPI 1457359291
  NPD (past)
• Zachary Allen Johnson, PA-C

  • Physician Assistant
  • Rolling Hills Estates, CA
  • NPI 1598233256
  NPD (past)

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1619351707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 N. DOUGLAS ST.",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "90245",
            "telephone_number": "310-906-2788",
            "fax_number": "310-906-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 N DOUGLAS ST.",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "90245",
            "telephone_number": "310-906-2788",
            "fax_number": "310-906-2786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL SEGUNDO DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "FELLMAN",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "310-906-2788"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100120719",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gardena Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jermaine Edwards
• Kyle-Olivier Efole
• Makayla Eggleston
• Kayla Christine Eichaker
• Eileen J. Bell
• El Segundo Endoscopy Center LLC
• El Segundo Medical Center Inc
• El Segundo Medical Center Inc.
• El Segundo Pharmacy Inc
• El Segundo Unified School District

• Specialist in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.