Healthcare Provider Details

I. General information

NPI: 1104405943
Provider Name (Legal Business Name): CALIFORNIA DERMATOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 OAK PARK LN STE 202
SANTA BARBARA CA
93105-4276
US

IV. Provider business mailing address

2323 OAK PARK LN STE 202
SANTA BARBARA CA
93105-4276
US

V. Phone/Fax

Practice location:
  • Phone: 805-892-8111
  • Fax: 805-892-8444
Mailing address:
  • Phone: 805-892-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: AEGEAN CHAN
Title or Position: OWNER
Credential: MD
Phone: 805-208-7656