Nicole Tien, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

61690 Issued in CA

Practice address

2221 Lincoln Blvd Ste 100
Santa Monica, CA 90405-1320

Phone

(310) 392-1111

Fax

(310) 392-1101

NPI assigned

Oct 25, 2022

Last updated

Oct 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Texas Medical Branch at Galveston, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Daniel Behroozan MD a Medical CorporationGroup PAC ID 2769482447, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Daniel Behroozan MD a Medical Corporation

  dba Dermatology Institute of Southern California

  • Dermatology Physician
  • Santa Monica, CA
  • NPI 1760544639
  Medicare reassignment Care Compare group NPD
• Dermatology Associates of Westlake

  • Specialist
  • Westlake Village, CA
  • NPI 1265401251
  NPD
• Amarpaul S Sidhu, M. D

  • Specialist
  • Glendora, CA
  • NPI 1538301379
  NPD (past)
• Foothill Dermatology Medical Center

  • Specialist
  • Glendora, CA
  • NPI 1154592368
  NPD (past)

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1861119356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 LINCOLN BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051320",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 LINCOLN BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051320",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9090 Burton Way",
            "address_purpose": "LOCATION",
            "city": "Beverly Hills",
            "state": "CA",
            "postal_code": "902111661",
            "country_code": "US",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIEN",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "61690",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.