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General NPI Number Information
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NPI Number | 1750939153
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Entity Type | Organization
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Legal Business Name | SAND DERMATOLOGY PC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 3110 CHINO AVE STE 120
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City | CHINO HILLS
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State | CA
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Zip | 91709-1294
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Country | US
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Telephone | 909-313-5111
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Fax | 909-313-0959
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Provider Business Mailing Address
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Address Line | 3110 CHINO AVE STE 120
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City | CHINO HILLS
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State | CA
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Zip | 91709-1294
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Country | US
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Telephone | 909-313-5111
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Fax | 909-313-0959
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KAMIL OUSHAN
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Credential | JD
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Telephone | 408-250-9667
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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 |
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License Number State |
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