NPIMap

Organization Active NPI

Sand Dermatology PC

  • Dermatology Physician
  • Chino Hills, CA
National Provider Identifier
1750939153
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SAND DERMATOLOGY PC
Practice address
3110 Chino Ave Ste 120
Chino Hills, CA 91709-1294
Phone
(909) 313-5111
Fax
(909) 313-0959
NPI assigned
Aug 28, 2019
Last updated
Dec 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

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

Authorized official

Name
Kamil Oushan, JD
Title
Practice Manager
Phone
(408) 250-9667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

3110 Chino Ave Ste 120
Chino Hills, CA 91709-1294

Mailing address

3110 Chino Ave Ste 120
Chino Hills, CA 91709-1294
Phone (909) 313-5111

National Provider Directory

National Provider Directory
Tax ID family
Sand Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3110 Chino Ave
Ste 120
Chino Hills, CA 91709
Phone (909) 313-5111

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575244800000",
    "number": "1750939153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 CHINO AVE STE 120",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917091294",
            "telephone_number": "909-313-5111",
            "fax_number": "909-313-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 CHINO AVE STE 120",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917091294",
            "telephone_number": "909-313-5111",
            "fax_number": "909-313-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-12-02",
        "status": "A",
        "authorized_official_last_name": "OUSHAN",
        "authorized_official_first_name": "KAMIL",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "408-250-9667",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; 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.