Healthcare Provider Details

I. General information

NPI: 1629997895
Provider Name (Legal Business Name): SKINMD DERMATOLOGY AND COSMETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 AIRLINE HWY STE 103
BATON ROUGE LA
70805-1715
US

IV. Provider business mailing address

1213 N CICERO AVE
BATON ROUGE LA
70816-1855
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-5312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA CHU
Title or Position: OWNER
Credential: MD
Phone: 225-810-5312