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General NPI Number Information
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NPI Number | 1326150913
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Entity Type | Organization
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Legal Business Name | LASER & SKIN SURGERY MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 3835 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-5520
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Country | US
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Telephone | 916-456-0400
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Fax | 916-340-0621
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Provider Business Mailing Address
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Address Line | 3835 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-5520
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Country | US
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Telephone | 916-456-0400
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Fax | 916-340-0621
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUZANNE L KILMER
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Credential | MD
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Telephone | 916-456-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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