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General NPI Number Information
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NPI Number | 1205593316
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Entity Type | Organization
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Legal Business Name | SHINE FUNCTIONAL DERMATOLOGY
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 566 E ST
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City | LINCOLN
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State | CA
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Zip | 95648-1861
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Country | US
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Telephone | 916-645-1447
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Fax | 916-645-1447
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Provider Business Mailing Address
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Address Line | 566 E ST
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City | LINCOLN
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State | CA
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Zip | 95648-1861
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Country | US
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Telephone | 916-645-1447
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Fax | 866-502-3465
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. KATHRINE M VARMAN
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Credential | MD
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Telephone | 916-953-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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