Provider Demographics
NPI:1407825128
Name:UC REGENTS UCLA DMPG DERMATIOLOGY
Entity Type:Organization
Organization Name:UC REGENTS UCLA DMPG DERMATIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:OYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-206-0644
Mailing Address - Street 1:PO BOX 24DD5 WESTWOOD STATION
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-301-8708
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:1131 WILSHIRE BLVD
Practice Address - Street 2:UC REGENTS UCLA DMPG DERMATOLOGY SUITE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2061
Practice Address - Country:US
Practice Address - Phone:310-917-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Not Answered207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11919AOtherMEDICARE PROVIDER NUMBER