Radiant Dermatology, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A127029 Issued in CA

Legal business name

RADIANT DERMATOLOGY, INC.

Practice address

421 N Rodeo Dr Ste T7
Beverly Hills, CA 90210-4531

Phone

(310) 274-5372

NPI assigned

Dec 9, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jenna Natalie Queller, MD

Title

Medical Director

Phone

(424) 208-3251

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1512777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512777600000",
    "number": "1689189854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10501 EASTBORNE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246001",
            "telephone_number": "424-208-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N RODEO DR STE T7",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104531",
            "telephone_number": "310-274-5372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-09",
        "last_updated": "2017-12-09",
        "status": "A",
        "authorized_official_last_name": "QUELLER",
        "authorized_official_first_name": "JENNA",
        "authorized_official_middle_name": "NATALIE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "424-208-3251",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A127029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Beverly Hills, CA
• Providers in Beverly Hills, 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 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.