1. Home
  2. Directory
  3. California
  4. El Segundo
  5. Specialist
  6. NPI Profile

GARDENA DERMATOLOGY
NPI 1619351707
Specialist in El Segundo, CA

Active since July 17, 2015CLIA 05D2113648 · Certificate of Compliance
713 N DOUGLAS ST., EL SEGUNDO, CA 90245(310) 906-2788(310) 906-2786 Get Directions Write a Review

NPPES record last updated: August 11, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 11, 2022, Mar 24, 2021, Feb 11, 2020 and 3 more (6 updates tracked since 2016).

About Gardena Dermatology NPPES

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

GARDENA DERMATOLOGY (NPI 1619351707) is a healthcare organization registered as a specialist in El Segundo, California and active in the NPI registry since July 2015. The organization holds a CLIA Certificate of Compliance certificate valid through February 8, 2027 and lists Brenda Fellman, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1619351707
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameEL SEGUNDO DERMATOLOGY, INC.
Location Address713 N DOUGLAS ST.El Segundo, CA 90245
Mailing Address713 N. Douglas St.El Segundo, CA 90245 · (310) 906-2788 · Fax (310) 906-2786
Phone(310) 906-2788
Fax(310) 906-2786
Organization SubpartNo
Authorized OfficialBrenda FellmanPractice Manager · (310) 906-2788
Enumeration DateJuly 17, 2015
Last NPPES UpdateAugust 11, 20226 updates tracked since enumeration
NPPES CertifiedAugust 11, 2022
✔ NPI 1619351707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
713 N DOUGLAS ST., El Segundo, CA 90245
Open in Google Maps ↗

Other Names 1

Doing Business AsGardena Dermatology

Other Identifiers 1

Medicaid100120719CA

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)

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

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Gardena Dermatology, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Ashley Magovern, M.D.
Dermatology
NPI 1770761207
400 S SEPULVEDA BLVD SUITE 205
Manhattan Beach, CA 90266
(310) 546-1188
✔ PECOS✔ Accepts Medicare2.1 mi
Ardeshir Nadimi, M.D.
Dermatology
NPI 1992190417
12555 W JEFFERSON BLVD STE 202
Los Angeles, CA 90066
(424) 541-1756
✔ PECOS✔ Accepts Medicare5.4 mi
Melissa Camouse, D.O.
Dermatology
NPI 1689885279
23456 HAWTHORNE BLVD STE 100
Torrance, CA 90505
(310) 540-5272
✔ PECOS✔ Accepts Medicare6.7 mi
Malcolm Ke, MD
Dermatology
NPI 1245269984
23456 HAWTHORNE BLVD STE 100
Torrance, CA 90505
(310) 540-5272
✔ PECOS✔ Accepts Medicare6.7 mi
Jill Javahery, M.D.
Dermatology
NPI 1568647022
3918 LONG BEACH BLVD STE 200
Long Beach, CA 90807
(562) 997-1144
✔ PECOS✔ Accepts Medicare12 mi
Courtney Phillips, M.D.
Dermatology
NPI 1215370960
1200 N STATE ST # 3250
Los Angeles, CA 90033
(323) 226-3372
✔ PECOS✔ Accepts Medicare15 mi

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

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 05D2113648

El Segundo Dermatology Inc · El Segundo, CA
Active · expires Feb 8, 2027
CLIA Number05D2113648
Laboratory TypePhysician Office
Certificate Effective DateFebruary 9, 2025
Certificate Expiration DateFebruary 8, 2027
Laboratory DirectorJill H. Javahery
Laboratory Phone(310) 906-2788
Laboratory LocationEl Segundo Dermatology Inc713 N Douglas St, El Segundo, CA 90245
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.

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 El Segundo Dermatology, Inc.'s NPI number?

The NPI number for El Segundo Dermatology, Inc. is 1619351707. It was assigned to this organization in the NPPES registry on July 17, 2015. The provider is doing business as Gardena Dermatology.

Where is El Segundo Dermatology, Inc. located?

El Segundo Dermatology, Inc. is located at 713 N Douglas St., El Segundo, CA 90245. The listed phone number is (310) 906-2788.

What is El Segundo Dermatology, Inc.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is El Segundo Dermatology, Inc. enrolled in Medicare?

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

How many clinicians bill Medicare through El Segundo Dermatology, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Dermatology, reassign their Medicare billing to El Segundo 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. Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does El Segundo Dermatology, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D2113648) is associated with this NPI, valid through February 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for El Segundo Dermatology, Inc. was last updated on August 11, 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.