NPIMap

Organization Active NPI

Comprehensive Dermatology Center of Pasadena, a Medical Group

  • Medical Specialty Clinic/Center
  • Pasadena, CA
National Provider Identifier
1740485010
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
A80177 Issued in CA
Legal business name
COMPREHENSIVE DERMATOLOGY CENTER OF PASADENA, A MEDICAL GROUP
Practice address
625 S Fair Oaks Ave
Suite 200
Pasadena, CA 91105-2613
Phone
(626) 793-7790
Fax
(626) 793-9018
NPI assigned
Jun 18, 2007
Last updated
Jul 6, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
COMPREHENSIVE DERMATOLOGY CENTER OF PASADENA, A MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Dr. Han N. Lee, M.D.NPI 1558457143
Title
Director
Phone
(626) 793-7790

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
Medical Specialty Clinic/Center 261QM2500X A80177 CA Primary

Addresses

Primary practice location

625 S Fair Oaks Ave
Suite 200
Pasadena, CA 91105-2613

Mailing address

625 S Fair Oaks Ave
Suite 200
Pasadena, CA 91105-2613
Phone (626) 793-7790

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110708000403 CA Part B Supplier - Clinic/Group Practice 3173701497 Receives reassigned benefits from 13 practitioners
Practice locations: Pasadena, CA

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
05D2024886Comprehensive Dermatology Center of Pasadena625 S Fair Oaks Ave Ste 200, Pasadena, CA 91105ComplianceJul 31, 2026

National Provider Directory

National Provider Directory
Part of
Comp Derma Ctr of Pasadena

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 & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1740485010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S FAIR OAKS AVE",
            "address_2": "SUITE 200",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052613",
            "telephone_number": "626-793-7790",
            "fax_number": "626-793-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S FAIR OAKS AVE",
            "address_2": "SUITE 200",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052613",
            "telephone_number": "626-793-7790",
            "fax_number": "626-793-9018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE DERMATOLOGY CENTER OF PASADENA, A MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMPREHENSIVE DERMATOLOGY CENTER OF PASADENA, A MEDICAL GROUP",
        "enumeration_date": "2007-06-18",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "HAN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "626-793-7790",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A80177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.