| Az Skin Sub LLC | |
|
10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 | |
| (480) 389-6863 | |
| (888) 819-9648 |
| Full Name | Az Skin Sub LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 10810 N Tatum Blvd Ste 102-132, Phoenix, Arizona |
| Authorized Official Name and Position | Jarvis Tzeng (PRESIDENT) |
| Authorized Official Contact | 4803896863 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Az Skin Sub LLC 10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 Ph: (480) 389-6863 | Az Skin Sub LLC 10810 N Tatum Blvd Ste 102-132 Phoenix AZ 85028-6055 Ph: (480) 389-6863 |
| NPI Number | 1912618687 |
|---|---|
| Provider Enumeration Date | 12/13/2022 |
| Last Update Date | 12/13/2022 |
| Certification Date | 12/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912618687 | NPI | - | NPPES |
| 1811137722 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
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