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General NPI Number Information
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NPI Number | 1790246841
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Entity Type | Organization
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Legal Business Name | OCEAN SKIN AND VEIN INSTITUTE
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 13420 NEWPORT AVE STE G
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City | TUSTIN
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State | CA
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Zip | 92780-3745
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Country | US
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Telephone | 310-847-9693
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Fax |
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Provider Business Mailing Address
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Address Line | 932 RIVAS CANYON RD
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City | PACIFIC PLSDS
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State | CA
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Zip | 90272-3957
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Country | US
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Telephone | 310-847-9693
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIVYA SHOKEEN
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Credential | MD
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Telephone | 310-847-9693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 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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