Provider Demographics
NPI:1174517890
Name:BIERMAN CENTURY CITY DERM
Entity type:Organization
Organization Name:BIERMAN CENTURY CITY DERM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-553-3567
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-3567
Mailing Address - Fax:310-553-4538
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1008
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-3567
Practice Address - Fax:310-553-4538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19760207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER
CAW901OtherPTAN FOR BIERMAN CENTURY CITY DERMATOLOGY MED GRP
CA00A19760OtherPROVIDER NUMBER
CAWA19760BOtherPTAN FOR STANLEY M. BIERMAN