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ISLAND DERMATOLOGY, INC
NPI 1508815556
Dermatology in Newport Beach, CA

Active since May 08, 2006CLIA Certified · 2 labs
360 SAN MIGUEL DR, SUITE 501, NEWPORT BEACH, CA 92660(949) 720-1170(949) 720-1172 Get Directions Write a Review

NPPES record last updated: October 21, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 21, 2022, Oct 22, 2018, Oct 16, 2018 (3 updates tracked since 2018).

About Island Dermatology, Inc NPPES

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

ISLAND DERMATOLOGY, INC (NPI 1508815556) is a healthcare organization registered as a dermatology in Newport Beach, California and active in the NPI registry since May 2006. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Hesperia, and lists Navid Nami, Cheif Finacial Officer, as its authorized official.

NPPES Registry Identity

NPI1508815556
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameISLAND DERMATOLOGY, INC
Location Address360 SAN MIGUEL DR, SUITE 501Newport Beach, CA 92660-7853
Mailing Address360 San Miguel Dr, Suite 501Newport Beach, CA 92660-7853 · (949) 720-1170 · Fax (949) 720-1172
Phone(949) 720-1170
Fax(949) 720-1172
Organization SubpartNo
Authorized OfficialNavid NamiCheif Finacial Officer · (949) 720-1170
Enumeration DateMay 8, 2006
Last NPPES UpdateOctober 21, 20223 updates tracked since enumeration
NPPES CertifiedOctober 21, 2022
✔ NPI 1508815556 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
360 SAN MIGUEL DR, Newport Beach, CA 92660
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Secondary Practice Location 1

Location 116785 Bear Valley Rd Ste 5Hesperia, CA 92345-0825 · Phone (760) 951-7762 · Fax (760) 951-7134

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 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)

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

Clinicians Billing Medicare Through This Organization

25

Medicare enrollment records show 25 clinicians reassign Medicare billing to Island Dermatology, Inc, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 8 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 6

Dermatology17
Nurse Practitioner4
General Practice1
Micrographic Dermatologic Surgery (MDS)1
Pathology1
Radiation Oncology1

Nearest to this location (20)

See all 25
Joyce Yuan, M.D.
Dermatology
NPI 1972940187
360 SAN MIGUEL DR STE 501
Newport Beach, CA 92660
(949) 720-1170
✔ PECOS✔ Accepts MedicareSame address
Leela Athalye, D.O.
Dermatology
NPI 1093097818
360 SAN MIGUEL DR STE 501
Newport Beach, CA 92660
(949) 720-1170
✔ PECOS✔ Accepts MedicareSame address
Leila Ettefagh, M.D.
Dermatology
NPI 1881643724
360 SAN MIGUEL DR SUITE 501
Newport Beach, CA 92660
(949) 720-1170
✔ PECOS✔ Accepts MedicareSame address
Navid Nami, D.O.
Dermatology
NPI 1710936646
360 SAN MIGUEL DR SUITE 501
Newport Beach, CA 92660
(949) 720-1170
✔ PECOS✔ Accepts MedicareSame address
Shibani Shah
Nurse Practitioner
NPI 1326719063
1441 AVOCADO AVE STE 409
Newport Beach, CA 92660
(949) 640-4501
✔ PECOS✔ Accepts Medicare0.1 mi
Marjon Vatanchi, M.D.
Dermatology
NPI 1073951109
6865 ALTON PKWY STE 210
Irvine, CA 92618
(949) 800-8551
✔ PECOS✔ Accepts Medicare6.6 mi
Danielle Moul, M.D.
Dermatology
NPI 1700091113
303 BROADWAY ST STE 104 PMB 135
Laguna Beach, CA 92651
(410) 952-6996
✔ PECOS✔ Accepts Medicare7.0 mi
Rollin Green, MD
Dermatology
NPI 1245206705
24012 CALLE DE LA PLATA STE 200
Laguna Hills, CA 92653
(949) 452-3841
✔ PECOS9.3 mi
Joseph Kamel, DO
Dermatology
NPI 1003304759
15 MAREBLU STE 240
Aliso Viejo, CA 92656
(949) 810-3376
✔ PECOS✔ Accepts Medicare10 mi
Bijan Haghighi, M.D.
Pathology
NPI 1790868909
805 W LA VETA AVE STE 104
Orange, CA 92868
(714) 288-4044
✔ PECOS12 mi
Robert Langer, MD
Dermatology
NPI 1093886046
441 N LAKEVIEW AVE
Anaheim, CA 92807
(888) 988-2800
✔ PECOS✔ Accepts Medicare17 mi
David Arnold, DO
General Practice
NPI 1003311051
8345 FIRESTONE BLVD STE 310
Downey, CA 90241
(652) 923-3001
✔ PECOS✔ Accepts Medicare27 mi
Cecilia Ann, NP
Nurse Practitioner
NPI 1306212717
8345 FIRESTONE BLVD STE 310
Downey, CA 90241
(562) 923-3001
✔ PECOS✔ Accepts Medicare27 mi
Michelle Carhill, NP
Nurse Practitioner
NPI 1023873759
585 N MOUNTAIN AVE
Upland, CA 91786
(909) 608-7546
✔ PECOS✔ Accepts Medicare36 mi
Lance Chapman, M.D., MBA
Dermatology
NPI 1194143438
4733 W SUNSET BLVD FL 3
Los Angeles, CA 90027
(323) 783-0339
✔ PECOS✔ Accepts Medicare41 mi
Dominique Benjamin, RN, FNP
Nurse Practitioner
NPI 1790220879
11795 W OLYMPIC BLVD
Los Angeles, CA 90064
(888) 227-3312
✔ PECOS✔ Accepts Medicare44 mi
Andrew Breithaupt, M.D.
Micrographic Dermatologic Surgery (MDS)
NPI 1437460359
200 MED PLZ SUITE 450
Los Angeles, CA 90095
(310) 825-6911
✔ PECOS✔ Accepts Medicare46 mi
Stephanie Martin, M.D.
Dermatology
NPI 1891053419
16260 VENTURA BLVD
Encino, CA 91436
(818) 788-4022
✔ PECOS✔ Accepts Medicare52 mi
Richard Le, DO
Dermatology
NPI 1417070566
12611 HESPERIA RD STE A
Victorville, CA 92395
(760) 951-7762
✔ PECOS68 mi
Wendy Roberts, M.D.
Dermatology
NPI 1689663635
39700 BOB HOPE DR SUITE 115
Rancho Mirage, CA 92270
(760) 346-4262
✔ PECOS✔ Accepts Medicare85 mi
See all 25 clinicians

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

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D1056357

Island Dermatology · Newport Beach, CA
Active · expires Feb 20, 2027
CLIA Number05D1056357
Laboratory TypePhysician Office
Certificate Effective DateFebruary 21, 2025
Certificate Expiration DateFebruary 20, 2027
Laboratory DirectorLeila Ettefagh MD
Laboratory Phone(949) 720-1170
Laboratory LocationIsland Dermatology360 San Miguel Dr, Ste 501, Newport Beach, CA 92660
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 05D2288775

Island Dermatology Dba Santa Ana Dermatology · Santa Ana, CA
Active · expires Aug 29, 2027
CLIA Number05D2288775
Laboratory TypePhysician Office
Certificate Effective DateAugust 30, 2025
Certificate Expiration DateAugust 29, 2027
Laboratory DirectorLeila Ettefagh
Laboratory Phone(949) 720-1170
Laboratory LocationIsland Dermatology Dba Santa Ana Dermatology2621 S Bristol St Suite 309, Santa Ana, CA 92704
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Island Dermatology, Inc's NPI number?

The NPI number for Island Dermatology, Inc is 1508815556. It was assigned to this organization in the NPPES registry on May 8, 2006.

Where is Island Dermatology, Inc located?

Island Dermatology, Inc is located at 360 San Miguel Dr Suite 501, Newport Beach, CA 92660. The listed phone number is (949) 720-1170.

What is Island Dermatology, Inc's specialty?

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

Is Island Dermatology, Inc enrolled in Medicare?

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

How many clinicians bill Medicare through Island Dermatology, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 25 clinicians in 6 Medicare specialties reassign their Medicare billing to Island 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. The largest specialties are Dermatology (17), Nurse Practitioner (4) and General Practice (1). Of these, 4 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Island Dermatology, Inc hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Island Dermatology, Inc was last updated on October 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.