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General NPI Number Information
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NPI Number | 1912878877
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Entity Type | Organization
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Legal Business Name | MKSKINMD
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3925 SOUTH PRESTON ROAD UNIT 103
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City | CELINA
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State | TX
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Zip | 75009
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Country | US
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Telephone | 214-214-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 MAIN ST STE 214-1053
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City | THE COLONY
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State | TX
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Zip | 75056-2250
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Country | US
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Telephone | 206-992-7192
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MAHSA KARAVAN JAHROMI
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Credential | MD
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Telephone | 206-992-7192
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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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