Provider Demographics
NPI:1790246841
Name:OCEAN SKIN AND VEIN INSTITUTE
Entity Type:Organization
Organization Name:OCEAN SKIN AND VEIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-847-9693
Mailing Address - Street 1:932 RIVAS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PLSDS
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3957
Mailing Address - Country:US
Mailing Address - Phone:310-847-9693
Mailing Address - Fax:
Practice Address - Street 1:13420 NEWPORT AVE STE G
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:310-847-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty