SHANTHIMD DERMATOLOGY, INC.
NPI 1245698752
Dermatology in Los Angeles, CA

Active since January 29, 2016
2990 S SEPULVEDA BLVD, SUITE 300, LOS ANGELES, CA 90064(323) 421-4747(949) 955-7351 Get Directions Write a Review

NPPES record last updated: July 24, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 24, 2024, May 18, 2016, Jan 29, 2016 (3 updates tracked since 2016).

About Shanthimd Dermatology, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANTHIMD DERMATOLOGY, INC. (NPI 1245698752) is a healthcare organization registered as a dermatology in Los Angeles, California and active in the NPI registry since January 2016. The organization lists Shanthi Marie Colaco, Ceo/owner, as its authorized official.

NPPES Registry Identity

NPI1245698752
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSHANTHIMD DERMATOLOGY, INC.
Location Address2990 S SEPULVEDA BLVD, SUITE 300Los Angeles, CA 90064-0002
Mailing Address2990 S Sepulveda Blvd, Suite 300Los Angeles, CA 90064-0002 · (323) 421-4747 · Fax (949) 955-7351
Fax(949) 955-7351
Organization SubpartNo
Authorized OfficialShanthi Marie ColacoCeo/owner · (323) 421-4747
Enumeration DateJanuary 29, 2016
Last NPPES UpdateJuly 24, 20243 updates tracked since enumeration
NPPES CertifiedJuly 24, 2024
✔ NPI 1245698752 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in CA · A123314
Definition
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.
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License A123314 (CA)
2990 S SEPULVEDA BLVD, Los Angeles, CA 90064

Other Names 1

Doing Business AsShanthimd Dermatology, Inc.

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shanthimd Dermatology, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shanthimd Dermatology, Inc., which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1144482167
2990 S SEPULVEDA BLVD SUITE 300
Los Angeles, CA 90064
(323) 421-4747
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shanthimd Dermatology, Inc.'s NPI number?

The NPI number for Shanthimd Dermatology, Inc. is 1245698752. It was assigned to this organization in the NPPES registry on January 29, 2016.

Where is Shanthimd Dermatology, Inc. located?

Shanthimd Dermatology, Inc. is located at 2990 S Sepulveda Blvd Suite 300, Los Angeles, CA 90064. The listed phone number is (323) 421-4747.

What is Shanthimd Dermatology, Inc.'s specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Shanthimd Dermatology, Inc. enrolled in Medicare?

Yes. Shanthimd Dermatology, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shanthimd Dermatology, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Shanthimd Dermatology, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Shanthimd Dermatology, Inc. was last updated on July 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.