Healthcare Provider Details

I. General information

NPI: 1740470053
Provider Name (Legal Business Name): SKIN SURGERY CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 W HILLCREST DRIVE
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

267 W HILLCREST DRIVE
THOUSAND OAKS CA
91360
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-1694
  • Fax: 805-449-4184
Mailing address:
  • Phone: 805-497-1694
  • Fax: 805-449-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW JOHN KAUFMAN
Title or Position: OWNER
Credential: MD
Phone: 805-497-1694