MEDICARE: BRENTWOOD DERMATOLOGY MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1427089911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENTWOOD DERMATOLOGY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	11980 SAN VICENTE BLVD.
Second Line	:	SUITE # 120
City	:	LOS ANGELES
State	:	CA
Zip	:	90049
Country	:	US
Telephone Number	:	310-826-2051
Fax Number	:	310-979-0185

Provider Business Practice Location Address
First Line	:	11980 SAN VICENTE BLVD
Second Line	:	SUITE # 120
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5012
Country	:	US
Telephone Number	:	310-826-2051
Fax Number	:	310-979-0185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK H SILVERS
Credential	:	M.D.
Telephone Number	:	310-826-2051

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/08/2025

Similar Medicare Providers

1982169595 — ORIGIN PHYSICAL THERAPY CA INC
Practice Location Address:

11980 SAN VICENTE BLVD STE 100
LOS ANGELES, CA
90049-5012

Practice Phone: 310-241-4885
Practice Fax: 310-479-2329

1033109335 — DR. HOPE W LEVIN MD
Practice Location Address:

11980 SAN VICENTE BLVD , SUITE 809
LOS ANGELES, CA
90049-5012

Practice Phone: 310-494-0108
Practice Fax: 310-943-9012

1639157100 — DR. PATRICK T. BEZDEK M.D.
Practice Location Address:

11980 SAN VICENTE BLVD , SUITE 904
LOS ANGELES, CA
90049-5012

Practice Phone: 310-820-2995
Practice Fax: 310-454-2587

1316905326 — UC REGENTS UCLA DMPG BRENTWOOD
Practice Location Address:

11980 SAN VICENTE BLVD , SUITE 102
LOS ANGELES, CA
90049-5012

Practice Phone: 310-208-7777
Practice Fax:

1235172727 — DR. DAVID ETHAN SONES M.D.
Practice Location Address:

11980 SAN VICENTE BLVD , SUITE 701
LOS ANGELES, CA
90049-5012

Practice Phone: 310-207-2006
Practice Fax:

1649214784 — DR. JACK SILVERS M.D
Practice Location Address:

11980 SAN VICENTE BLVD , SUITE 120
LOS ANGELES, CA
90049-5012

Practice Phone: 310-826-2051
Practice Fax: 310-979-0185

Directions to “BRENTWOOD DERMATOLOGY MEDICAL GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.