Healthcare Provider Details

I. General information

NPI: 1083387898
Provider Name (Legal Business Name): NEAR ME DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD STE A110
WEST SENECA NY
14224-2646
US

IV. Provider business mailing address

1170 MAPLE RD
WILLIAMSVILLE NY
14221-3440
US

V. Phone/Fax

Practice location:
  • Phone: 716-650-5720
  • Fax: 716-650-4618
Mailing address:
  • Phone: 213-880-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YOUN JEA KIM
Title or Position: CHAIRMAN OF THE BOAD
Credential: FNP
Phone: 213-880-2538