Healthcare Provider Details

I. General information

NPI: 1407825128
Provider Name (Legal Business Name): UC REGENTS UCLA DMPG DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 WILSHIRE BLVD UC REGENTS UCLA DMPG DERMATOLOGY SUITE 200
SANTA MONICA CA
90401-2061
US

IV. Provider business mailing address

PO BOX 24DD5 WESTWOOD STATION
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-917-3376
  • Fax:
Mailing address:
  • Phone: 310-301-8708
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT K OYE
Title or Position: VICE CHAIR OF CLINICAL SERVICES
Credential: MD
Phone: 310-206-0644