Provider Demographics
NPI:1386195204
Name:K DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:K DERMATOLOGY PLLC
Other - Org Name:K DERMATOLOGY & WELLNESS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORIAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-469-3376
Mailing Address - Street 1:399 W CAMPBELL RD STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3636
Mailing Address - Country:US
Mailing Address - Phone:972-469-3376
Mailing Address - Fax:972-469-3288
Practice Address - Street 1:399 W CAMPBELL RD STE 410
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3636
Practice Address - Country:US
Practice Address - Phone:972-469-3376
Practice Address - Fax:972-469-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3746207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty