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General NPI Number Information
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NPI Number | 1386195204
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Entity Type | Organization
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Legal Business Name | K DERMATOLOGY PLLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 399 W CAMPBELL RD STE 410
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City | RICHARDSON
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State | TX
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Zip | 75080-3636
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Country | US
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Telephone | 972-469-3376
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Fax | 972-469-3288
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Provider Business Mailing Address
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Address Line | 399 W CAMPBELL RD STE 410
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City | RICHARDSON
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State | TX
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Zip | 75080-3636
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Country | US
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Telephone | 972-469-3376
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Fax | 972-469-3288
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGIE KORIAKOS
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Credential | D.O.
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Telephone | 972-469-3376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | P3746
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License Number State | TX
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