Provider Demographics
NPI:1104405943
Name:CALIFORNIA DERMATOLOGY GROUP PC
Entity type:Organization
Organization Name:CALIFORNIA DERMATOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AEGEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-208-7656
Mailing Address - Street 1:2323 OAK PARK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4276
Mailing Address - Country:US
Mailing Address - Phone:805-892-8111
Mailing Address - Fax:
Practice Address - Street 1:2323 OAK PARK LN STE 202
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4276
Practice Address - Country:US
Practice Address - Phone:805-892-8111
Practice Address - Fax:805-892-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty