LACA DERMATOLOGY,INC
NPI 1811497928
Dermatology - MOHS-Micrographic Surgery in Sherman Oaks, CA

Q: What is Laca Dermatology, Inc's NPI number?

The NPI number for Laca Dermatology, Inc is 1811497928. It was assigned to this organization in the NPPES registry on February 15, 2018. The provider is doing business as Laca Dermatology,inc and Laca Dermatology Inc.

Q: What is Laca Dermatology, Inc's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since February 15, 2018CLIA 05D2130455 · Certificate of Compliance

4955 VAN NUYS BLVD STE 516, SHERMAN OAKS, CA 91403(818) 789-6296(818) 789-0374 Get Directions Write a Review

NPPES record last updated: March 25, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 8, 2019, Feb 15, 2018 (2 updates tracked since 2018).

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About Laca Dermatology,inc NPPES

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

LACA DERMATOLOGY,INC (NPI 1811497928) is a healthcare organization registered as a mohs-micrographic surgery in Sherman Oaks, California and active in the NPI registry since February 2018. The organization holds a CLIA Certificate of Compliance certificate valid through March 12, 2028 and lists Kathleen Vine, Md, as its authorized official.

NPPES Registry Identity

NPI1811497928

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameLACA DERMATOLOGY, INC

Location Address4955 VAN NUYS BLVD STE 516Sherman Oaks, CA 91403-1832

Mailing Address1920 Hillhurst Ave #158Los Angeles, CA 90027-3352 · (818) 789-6296 · Fax (818) 789-0374

Phone(818) 789-6296

Fax(818) 789-0374

Organization SubpartNo

Authorized OfficialKathleen VineMd · (818) 789-6296

Enumeration DateFebruary 15, 2018

Last NPPES UpdateMarch 25, 20192 updates tracked since enumeration

✔ NPI 1811497928 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

License✔ Licensed in CA · C53733

Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

4955 VAN NUYS BLVD STE 516, Sherman Oaks, CA 91403

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Other Names 2

Doing Business AsLaca Dermatology,inc

Doing Business AsLaca Dermatology Inc

Other Identifiers 1

Other1487636858NY · Individual Npi

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)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Laca Dermatology,inc, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Kathleen Vine, M.D.

Dermatology

NPI 1659534410

928 BROADWAY SUITE 301
New York, NY 10010

(646) 421-6064

✔ PECOS✔ Accepts Medicare2,459 mi

Anne Hardick Dacko, MD

Dermatology

NPI 1487636858

20408 ROCKAWAY POINT BLVD
Breezy Point, NY 11697

(646) 421-6064

✔ PECOS✔ Accepts Medicare2,464 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 05D2130455

Laca Dermatology Inc · Sherman Oaks, CA

Active · expires Mar 12, 2028

CLIA Number05D2130455

Laboratory TypePhysician Office

Certificate Effective DateMarch 13, 2026

Certificate Expiration DateMarch 12, 2028

Laboratory DirectorAnne C. Hardick Dacko

Laboratory Phone(818) 789-6296

Laboratory LocationLaca Dermatology Inc4955 Van Nuys Blvd, Ste 516, Sherman Oaks, CA 91403

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 Laca Dermatology, Inc's NPI number?

The NPI number for Laca Dermatology, Inc is 1811497928. It was assigned to this organization in the NPPES registry on February 15, 2018. The provider is doing business as Laca Dermatology,inc and Laca Dermatology Inc.

Where is Laca Dermatology, Inc located?

Laca Dermatology, Inc is located at 4955 Van Nuys Blvd Ste 516, Sherman Oaks, CA 91403. The listed phone number is (818) 789-6296.

What is Laca Dermatology, Inc's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Laca Dermatology, Inc enrolled in Medicare?

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

How many clinicians bill Medicare through Laca Dermatology, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Laca 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.

Does Laca Dermatology, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D2130455) is associated with this NPI, valid through March 12, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Laca Dermatology, Inc was last updated on March 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.