Healthcare Provider Details

I. General information

NPI: 1285260588
Provider Name (Legal Business Name): UPTOWN DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7628
US

IV. Provider business mailing address

8016 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7628
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-4309
  • Fax: 505-835-5687
Mailing address:
  • Phone: 505-508-4309
  • Fax: 505-835-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAN H BANG
Title or Position: PRESIDENT
Credential: MD
Phone: 505-508-4309