Provider Demographics
NPI:1912529637
Name:K DERMATOLOGY & AESTHETIC CENTER LLC
Entity type:Organization
Organization Name:K DERMATOLOGY & AESTHETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOKHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-401-5430
Mailing Address - Street 1:340 STATE ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 STATE ROUTE 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2433
Practice Address - Country:US
Practice Address - Phone:312-401-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty