Organization
BAYSIDE DERMATOLOGY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN CHEN M.D. (OWNER)
(858) 552-8096
Entity
Organization
Contact information
Practice address
8174 REGENTS RD APT 303, SAN DIEGO, CA 92122-1371
(858) 552-8096
Mailing address
8174 REGENTS RD APT 303, SAN DIEGO, CA 92122-1371
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A79823
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A79823
CA
207ND0900X
Dermatopathology Physician
A79823
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
A79823
CA
207NP0225X
Pediatric Dermatology Physician
A79823
CA
207NS0135X
Procedural Dermatology Physician
A79823
CA
Other
Enumeration date
07/12/2007
Last updated
07/12/2007
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