Provider Demographics
NPI:1144527060
Name:MASON DERMATOLOGY CENTER INC
Entity type:Organization
Organization Name:MASON DERMATOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUIAN JUIAN
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:M D PH D FAAD
Authorized Official - Phone:513-459-1988
Mailing Address - Street 1:4834 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6827
Mailing Address - Country:US
Mailing Address - Phone:519-459-1988
Mailing Address - Fax:513-459-1845
Practice Address - Street 1:4834 SOCIALVILLE FOSTER RD
Practice Address - Street 2:SUITE 20
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6827
Practice Address - Country:US
Practice Address - Phone:519-459-1988
Practice Address - Fax:513-459-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.05572207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty