DIAKONIAMED (NPI# 1699265868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699265868 |
| Entity Type | Organization |
| Organization Name | DIAKONIAMED |
| Other Organization Name | EXCEPTIONAL DERMATOLOGY CARE |
| Practice Address |
2720 N Harbor Blvd Ste 205 Fullerton CA 92835-2609 |
| Mailing Address |
301 W Bastanchury Rd Ste 140 Fullerton CA 92835-3427 |
| Practice Telephone | 7188825525 |
| Practice Fax Number | 7148825078 |
| Mailing Telephone | 7148825525 |
| Mailing Fax Number | 7148825078 |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2019-07-16 |
| Authorized Official Name | DR. DAVID SIRE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7148825525 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICAL LIC | A22972 | 01 |
| Other Name | Type Code |
|---|---|
| Exceptional Dermatology Care | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 301 W Bastanchury Rd Ste 140, Fullerton, CA 928353427 | 7148825525 | 7148825078 |
| Street Address |
2720 N HARBOR BLVD STE 205 |
| City | FULLERTON |
| State | CA |
| Zip Code | 92835-2609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548274996 | Amy Ngoc Nguyen | Dermatology | 2720 N Harbor Blvd Ste 205, Fullerton, CA 92835-2609 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538774302 | Natalie Baugh | Nutritionist | 333 W Bastanchury Rd 110, Fullerton, CA 92835 | 2020-09-09 |
| 1073127098 | Cecile Mae Sam | Physical Therapist | 2932 Clover Ct, Fullerton, CA 92835 | 2020-09-08 |
| 1861966087 | Kimson F Johnston | Marriage & Family Therapist | 1370 Brea Blvd Suite 210, Fullerton, CA 92835 | 2019-01-22 |
| 1134636327 | Michelle Harriman, Psychologist - A Professional Corporation | Psychologist | 1440 N Harbor Blvd Ste 808, Fullerton, CA 92835 | 2018-01-09 |
| 1659818631 | Jacqueline Rene Miller | Specialist/Technologist | 2610 Associated Rd, Apt A4, Fullerton, CA 92835 | 2017-01-27 |
| 1912361106 | John Nathaniel Alvarez | Psychiatry & Neurology | 401 E Imperial Highway, Fullerton, CA 92835 | 2016-04-13 |
| 1083075030 | Advance Recovery Solution, LLC | Substance Abuse Rehabilitation Facility | 3744 N Hermosa Pl, Fullerton, CA 92835 | 2016-03-17 |
| 1467817981 | Michele Ledesma | Physical Therapy Assistant | 2800 N. Harbor Blvd., Fullerton, CA 92835 | 2015-12-29 |
| 1467820571 | Jonghan Kang | Acupuncturist | 1321 N Harbor Blvd Ste 205, Fullerton, CA 92835 | 2015-09-04 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| Find all providers in zip 92835 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710046628 | David J. Sire | Dermatology | 301 W Bastanchury Rd Ste 140, Fullerton, CA 92835 | 2006-12-06 |
| 1851478358 | Bruce Park, M.d. A Professional Corporation | Dermatology | 1966 E Chapman Ave, Suite G, Fullerton, CA 92831-4142 | 2006-11-01 |
| 1841378825 | Bruce S Park | Dermatology | 1966 E Chapman Ave Ste G, Fullerton, CA 92831-4141 | 2006-11-01 |
| 1548274996 | Amy Ngoc Nguyen | Dermatology | 2720 N Harbor Blvd Ste 205, Fullerton, CA 92835-2609 | 2006-07-28 |
| 1710917513 | Edward E Aston Iv | Dermatology | 333 W Bastanchury Rd, Suite 110, Fullerton, CA 92835-3420 | 2006-07-04 |
| 1194772822 | Kristina A Holmkvist | Dermatology | 301 W Bastanchury Road, Suite 245, Fullerton, CA 92835 | 2006-05-28 |
| 1588665392 | Tobey Wu-kuo | Dermatology | 2720 N Harbor Blvd Ste 210, Fullerton, CA 92835-2626 | 2005-08-02 |
| 1083024681 | Jennifer Ledon | Dermatology | 1440 N Harbor Blvd Ste 300, Fullerton, CA 92835-4116 | 2014-05-05 |
| 1013283910 | Helia Eragi | Dermatology | 301 W Bastanchury Rd, Suite 210, Fullerton, CA 92835-3419 | 2012-03-26 |
| 1023272309 | Khaled Mahmoud Hassan | Dermatology | 2720 N Harbor Blvd, Ste 220, Fullerton, CA 92835-2609 | 2008-07-15 |
| Find all providers in FULLERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.