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General NPI Number Information
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NPI Number | 1871399725
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Entity Type | Organization
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Legal Business Name | TOTAL DERMATOLOGY PLLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 3900 JUNIUS ST STE 420
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City | DALLAS
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State | TX
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Zip | 75246-1615
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Country | US
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Telephone | 646-580-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 JUNIUS ST STE 420
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City | DALLAS
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State | TX
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Zip | 75246-1615
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SO YEON PAEK
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Credential | MD
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Telephone | 972-200-7446
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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 |
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License Number State |
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