Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.
GOLDEN STATE DERMATOLOGY ASSOCIATES INC.
Complete NPI Record 1700860871
Dermatology in Walnut Creek, CA
Active since December 02, 2005CLIA Certified · 6 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Golden State Dermatology Associates Inc. (NPI 1700860871), a dermatology organization in Walnut Creek, CA. All 45 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1700860871 Field 1/45
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/45
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/45
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: GOLDEN STATE DERMATOLOGY ASSOCIATES INC. Field 4/45
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/45
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/45
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 370 N WIGET LN STE 250 Field 7/45
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: WALNUT CREEK Field 8/45
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CA Field 9/45
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 945982488 Field 10/45
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/45
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9259457005 Field 12/45
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9259541822 Field 13/45
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 355 LENNON LN STE 255 Field 14/45
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: WALNUT CREEK Field 15/45
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CA Field 16/45
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 945982496 Field 17/45
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/45
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9259327704 Field 19/45
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9259327752 Field 20/45
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: ZIMMERMAN Field 23/45
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: JAY Field 24/45
- The first name of the authorized official.
- Authorized Official Middle Name: WILLIAM Field 25/45
- The middle name of the authorized official.
- Authorized Official Title or Position: PROVIDER Field 26/45
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9258132971 Field 27/45
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207N00000X Field 28/45
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 29/45
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207ND0101X Field 30/45
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 31/45
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 207ND0900X Field 32/45
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 33/45
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 207NS0135X Field 34/45
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 35/45
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: A487440 Field 36/45
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 01 Field 37/45
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: CA Field 38/45
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier Issuer 1: LICENSE Field 39/45
- The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
- Other Provider Identifier 2: 05D096539 Field 40/45
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 01 Field 41/45
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: CA Field 42/45
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier Issuer 2: CLIA NUMBER Field 43/45
- The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
- Is Organization Subpart: N Field 44/45
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Secondary Practice Locations 20
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
17600 Monterey Rd Ste A
Location 1/20Morgan Hill, CA 95037-3669 · Phone (669) 766-2021
230 N 1680 E Ste N1
Location 2/20St George, UT 84790-2596 · Phone (925) 945-7005
2990 S Sepulveda Blvd Ste 300
Location 3/20Los Angeles, CA 90064-3996 · Phone (323) 421-4747
1542 N Tracy Blvd # A
Location 4/20Tracy, CA 95376-2903 · Phone (209) 836-2220
5575 W Las Positas Blvd Ste 260
Location 5/20Pleasanton, CA 94588-5803 · Phone (925) 847-3020
355 Lennon Ln Ste 235
Location 6/20Walnut Creek, CA 94598-2544 · Phone (925) 357-9050 · Fax (925) 357-9040
1200 Central Blvd Ste D
Location 7/20Brentwood, CA 94513-2227 · Phone (925) 308-9510
5640 N Fresno St Ste 110
Location 8/20Fresno, CA 93710-6098 · Phone (559) 266-9906
2255 Ygnacio Valley Rd Ste B1
Location 9/20Walnut Creek, CA 94598-3335 · Phone (925) 945-7005 ext. 92594
5201 Norris Canyon Rd
Location 10/20San Ramon, CA 94583-5411 · Phone (925) 277-1300
8890 N Union Blvd Ste 207
Location 11/20Colorado Springs, CO 80920-2701 · Phone (925) 945-7005
1324 Nelson Ave
Location 12/20Modesto, CA 95350-5374 · Phone (209) 524-9481
355 Lennon Ln Ste 295
Location 13/20Walnut Creek, CA 94598-2563 · Phone (925) 945-7005
400 Taylor Blvd Ste 301
Location 14/20Pleasant Hill, CA 94523-2160 · Phone (925) 687-8882 · Fax (925) 318-9657
1000 Delbon Ave Ste 8
Location 15/20Turlock, CA 95382-2008 · Phone (209) 722-7801
6120 Mae Anne Ave Ste 1
Location 16/20Reno, NV 89523-4706 · Phone (775) 746-0196
8735 Sierra College Blvd Ste 200
Location 17/20Roseville, CA 95661-5992 · Phone (916) 721-2836
280 Baldwin Ave
Location 18/20San Mateo, CA 94401-3915 · Phone (650) 727-6008
410 E Yosemite Ave Ste C
Location 19/20Merced, CA 95340-8220 · Phone (209) 722-7801
1058 Murrieta Blvd
Location 20/20Livermore, CA 94550-4111 · Phone (925) 277-1300 ext. 92594
Other Provider Identifiers 2
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
A487440 Other
Identifier 1/2State: CA · Issuer: License
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
05D096539 Other
Identifier 2/2State: CA · Issuer: Clia Number
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
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