Provider Demographics
NPI:1841644804
Name:ADVANCED DERMATOLOGY AND SKIN SURGERY INC
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY AND SKIN SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YI-PIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-217-1905
Mailing Address - Street 1:4155 MOORPARK AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-217-1905
Mailing Address - Fax:408-244-1318
Practice Address - Street 1:14830 LOS GATOS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2053
Practice Address - Country:US
Practice Address - Phone:408-358-1256
Practice Address - Fax:408-358-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97430174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty