Unknown Individual – Dermatology Physician, NPI 1114918331

Unknown Individual is a healthcare provider. based in Beverly hills, California. specializing in Dermatology Physician. They hold a License No. G53029 (CA). The NPI Number for Unknown Individual is 1114918331

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114918331
Phone
(310) 659-5173
Address
415 N CRESCENT DR
Deactivation Date
4 March 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3106595173
Graduation Year
1983 (43 years ago)
PAC ID
8224299060
Professional Enrollment ID
I20120423000171
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 415, North Crescent Drive, Beverly Hills, Los Angeles County, California, 90210, United States

    SUITE 340

    BEVERLY HILLS, CA 902104860

    Phone: (310) 659-5173

    Fax: (310) 659-5174

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 90210)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1114918331.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Dermatology Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Beverly Hills, California?
For routing, start with Beverly Hills, California for Unknown Individual, then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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