Healthcare Provider Details

I. General information

NPI: 1376769265
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PINE AVE
LONG BEACH CA
90813-4325
US

IV. Provider business mailing address

917 PINE AVE
LONG BEACH CA
90813-4325
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-9700
  • Fax: 560-590-5583
Mailing address:
  • Phone: 562-590-9700
  • Fax: 560-590-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA86029
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA86029
License Number StateCA

VIII. Authorized Official

Name: DR. SHARAM YASHAR
Title or Position: MGR
Credential: MD
Phone: 562-590-9700