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General NPI Number Information
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NPI Number | 1043613862
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DERMATOLOGY CARE
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 2262 CAMINO RAMON
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City | SAN RAMON
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State | CA
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Zip | 94583-1353
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Country | US
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Telephone | 925-328-0255
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Fax | 925-328-0257
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Provider Business Mailing Address
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Address Line | 2262 CAMINO RAMON
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City | SAN RAMON
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State | CA
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Zip | 94583-1353
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Country | US
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Telephone | 925-328-0255
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Fax | 925-328-0257
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. OANHTUYET KATHY DAO
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Credential | PA-C
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Telephone | 408-784-8322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 51771
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License Number State | CA
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