Provider Demographics
NPI:1972000321
Name:SKIN JOY DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:SKIN JOY DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUSAYO
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-312-7552
Mailing Address - Street 1:9015 MOUNTAIN RIDGE DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7303
Mailing Address - Country:US
Mailing Address - Phone:512-312-7552
Mailing Address - Fax:512-714-4786
Practice Address - Street 1:9015 MOUNTAIN RIDGE DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7303
Practice Address - Country:US
Practice Address - Phone:512-312-7552
Practice Address - Fax:512-714-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ5053OtherLICENSE NUMBER
TXQ5053OtherSTATE MEDICAL LICENSE