Provider Demographics
NPI:1356483549
Name:IRIS GIN MD AND RODNEY GIN MD
Entity Type:Organization
Organization Name:IRIS GIN MD AND RODNEY GIN MD
Other - Org Name:KALIA DERMATOLOGY AND LASER CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-1000
Mailing Address - Street 1:PO BOX 39000
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:408-356-1000
Mailing Address - Fax:408-356-1125
Practice Address - Street 1:15055 LOS GATOS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2083
Practice Address - Country:US
Practice Address - Phone:408-356-1000
Practice Address - Fax:408-356-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA671270207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03739ZMedicare PIN