Healthcare Provider Details

I. General information

NPI: 1326712209
Provider Name (Legal Business Name): NEAR ME DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD
WEST SENECA NY
14224-2646
US

IV. Provider business mailing address

550 ORCHARD PARK RD
WEST SENECA NY
14224-2646
US

V. Phone/Fax

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

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: NP
Credential: NP
Phone: 716-650-5720