Provider Demographics
NPI:1205593316
Name:SHINE FUNCTIONAL DERMATOLOGY
Entity type:Organization
Organization Name:SHINE FUNCTIONAL DERMATOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-953-3812
Mailing Address - Street 1:566 E ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1861
Mailing Address - Country:US
Mailing Address - Phone:916-645-1447
Mailing Address - Fax:866-502-3465
Practice Address - Street 1:566 E ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1861
Practice Address - Country:US
Practice Address - Phone:916-645-1447
Practice Address - Fax:916-645-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty