Provider Demographics
NPI:1750939153
Name:SAND DERMATOLOGY PC
Entity type:Organization
Organization Name:SAND DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:408-250-9667
Mailing Address - Street 1:3110 CHINO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1294
Mailing Address - Country:US
Mailing Address - Phone:909-313-5111
Mailing Address - Fax:909-313-0959
Practice Address - Street 1:3110 CHINO AVE STE 120
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1294
Practice Address - Country:US
Practice Address - Phone:909-313-5111
Practice Address - Fax:909-313-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty