Provider Demographics
NPI:1972920759
Name:SKIN AND BEAUTY CENTER (SBC), INC.
Entity Type:Organization
Organization Name:SKIN AND BEAUTY CENTER (SBC), INC.
Other - Org Name:NORTHRIDGE DERMATOLOGY ASSOCIATES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAADAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-857-0777
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0853
Mailing Address - Country:US
Mailing Address - Phone:877-822-2223
Mailing Address - Fax:818-842-3208
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2310
Practice Address - Country:US
Practice Address - Phone:818-886-3884
Practice Address - Fax:818-886-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20415Medicare UPIN