Unknown Individual – Clinical & Laboratory Dermatological Immunology Physician, NPI 1740371269

Unknown Individual is a healthcare provider. based in Menlo park, California. specializing in Clinical & Laboratory Dermatological Immunology Physician. They hold a License No. G744750 (CA). The NPI Number for Unknown Individual is 1740371269

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1740371269
Phone
(650) 323-0276
Address
1225 CRANE STREET
Deactivation Date
16 January 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Secondary Phone
6503230276
Graduation Year
1981 (45 years ago)
PAC ID
7810170974
Group Practice PAC ID
2466772595
Professional Enrollment ID
I20110328000069
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1225, Crane Street, Menlo Park, San Mateo County, California, 94025, United States

    SUITE 102

    MENLO PARK, CA 94025

    Phone: (650) 323-0276

    Fax: (650) 323-8540

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $19.

Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.

Last reported payment date: 2024-12-20 • Largest payer in this snapshot: REVANCE THERAPEUTICS, INC. ($19).

Total Amount

$19

General + Research + Ownership

Payments

1

Total payment records

General Amount

$19

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-20

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths27183$0
99213Established patient office or other outpatient visit, 20-29 minutes268224$0
17000Destruction of precancer skin growth, 1 growth158135$0
99212Established patient office or other outpatient visit, 10-19 minutes11898$0
11102Biopsy of related skin growth, first growth7166$0
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Insurance plans in this area (ZIP 94025)

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Provider's Procedures

Unknown Individual performs procedures in Clinical & Laboratory Dermatological Immunology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYCA17003Destruction of 2-14 skin growths1153297

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466772595View full group profile
NameSpecialtyState
D E R M A T O L O G YCA
D E R M A T O L O G YTN
D E R M A T O L O G YMD

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1740371269?
NPI 1740371269 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Clinical & Laboratory Dermatological Immunology Physician. Clinical services aligned with this taxonomy classification.
Where in California is Unknown Individual registered?
Use Menlo Park, California as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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