NPIMap

Organization Active NPI

Ocean Skin and Vein Institute

  • Dermatology Physician
  • Tustin, CA
National Provider Identifier
1790246841
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
OCEAN SKIN AND VEIN INSTITUTE
Practice address
13420 Newport Ave Ste G
Tustin, CA 92780-3745
Phone
(310) 847-9693
NPI assigned
Mar 29, 2019
Last updated
Feb 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Authorized official

Name
Dr. Divya Shokeen, MDNPI 1205270832
Title
Owner
Phone
(310) 847-9693

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

13420 Newport Ave Ste G
Tustin, CA 92780-3745

Mailing address

932 Rivas Canyon Rd
Pacific Plsds, CA 90272-3957
Phone (310) 847-9693

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190524001960 CA Part B Supplier - Clinic/Group Practice 9335482835 Receives reassigned benefits from 28 practitioners
Practice locations: Manhattan Beach, CA; Torrance, CA; Tustin, 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
05D0932547Ocean Skin and Vein Institute Inc13420 Newport Ave, Ste G, Tustin, CA 92780ComplianceFeb 29, 2028

National Provider Directory

National Provider Directory

Locations

625 E Badillo St
Ste B
Covina, CA 91723

4201 Torrance Blvd
Ste 100
Torrance, CA 90503

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1790246841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 RIVAS CANYON RD",
            "city": "PACIFIC PLSDS",
            "state": "CA",
            "postal_code": "902723957",
            "telephone_number": "310-847-9693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13420 NEWPORT AVE STE G",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803745",
            "telephone_number": "310-847-9693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN SKIN AND VEIN INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-29",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "SHOKEEN",
        "authorized_official_first_name": "DIVYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-847-9693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.