Provider Demographics
NPI:1083120992
Name:MEDICAL DERMATOLOGY & COSMETIC CLINIC OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:MEDICAL DERMATOLOGY & COSMETIC CLINIC OF NORTHERN CALIFORNIA
Other - Org Name:UNIVERSITY SKIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-571-5200
Mailing Address - Street 1:650 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-771-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty