Provider Demographics
NPI:1922553734
Name:SKIN CLINIC PLLC
Entity Type:Organization
Organization Name:SKIN CLINIC PLLC
Other - Org Name:SKIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-221-3931
Mailing Address - Street 1:362 US ROUTE 1 STE 5
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1353
Mailing Address - Country:US
Mailing Address - Phone:207-221-3931
Mailing Address - Fax:405-551-8254
Practice Address - Street 1:362 US ROUTE 1 STE 5
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1353
Practice Address - Country:US
Practice Address - Phone:207-221-3931
Practice Address - Fax:405-551-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2368207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty