Provider Demographics
NPI:1912878877
Name:MKSKINMD PLLC
Entity type:Organization
Organization Name:MKSKINMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAVAN JAHROMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-992-7192
Mailing Address - Street 1:5000 MAIN ST STE 214-1053
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2250
Mailing Address - Country:US
Mailing Address - Phone:206-992-7192
Mailing Address - Fax:
Practice Address - Street 1:3925 SOUTH PRESTON ROAD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009
Practice Address - Country:US
Practice Address - Phone:214-214-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235549692OtherNPPES