Provider Demographics
NPI:1790732832
Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LLC
Entity type:Organization
Organization Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-1449
Mailing Address - Street 1:9900 N CENTRAL EXPY STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0928
Mailing Address - Country:US
Mailing Address - Phone:602-277-1449
Mailing Address - Fax:602-277-9984
Practice Address - Street 1:2224 W NORTHERN AVE
Practice Address - Street 2:SUITE D-300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4928
Practice Address - Country:US
Practice Address - Phone:602-277-1449
Practice Address - Fax:602-277-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCKHZMedicare PIN