Provider Demographics
NPI:1043613862
Name:CALIFORNIA DERMATOLOGY CARE
Entity Type:Organization
Organization Name:CALIFORNIA DERMATOLOGY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:OANHTUYET
Authorized Official - Middle Name:KATHY
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:408-784-8322
Mailing Address - Street 1:2262 CAMINO RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1353
Mailing Address - Country:US
Mailing Address - Phone:925-328-0255
Mailing Address - Fax:925-328-0257
Practice Address - Street 1:2262 CAMINO RAMON
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1353
Practice Address - Country:US
Practice Address - Phone:925-328-0255
Practice Address - Fax:925-328-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51771207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty