Provider Demographics
NPI:1518349794
Name:GOOD DERMATOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GOOD DERMATOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-497-2978
Mailing Address - Street 1:911 PALMS BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3927
Practice Address - Country:US
Practice Address - Phone:310-497-2978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty