Provider Demographics
NPI:1568699106
Name:BUTANI DERMATOLOGY INC
Entity Type:Organization
Organization Name:BUTANI DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-620-7600
Mailing Address - Street 1:255 S GRAND AVE APT 2403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3047
Mailing Address - Country:US
Mailing Address - Phone:213-620-7600
Mailing Address - Fax:
Practice Address - Street 1:170 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2801
Practice Address - Country:US
Practice Address - Phone:213-620-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty