Healthcare Provider Details

I. General information

NPI: 1023377082
Provider Name (Legal Business Name): AMERICAN SKIN INSTITUTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2101
US

IV. Provider business mailing address

4836 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2101
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-7546
  • Fax: 818-907-9506
Mailing address:
  • Phone: 818-907-7546
  • Fax: 818-907-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA79982
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA79982
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA79982
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA79982
License Number StateCA

VIII. Authorized Official

Name: DR. ILYA REYTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-907-7546