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General NPI Number Information
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NPI Number | 1972000321
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Entity Type | Organization
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Legal Business Name | SKIN JOY DERMATOLOGY PLLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 9015 MOUNTAIN RIDGE DR. SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78759-7303
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Country | US
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Telephone | 512-312-7552
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Fax | 512-714-4786
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Provider Business Mailing Address
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Address Line | 9015 MOUNTAIN RIDGE DR. SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78759-7303
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Country | US
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Telephone | 512-312-7552
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Fax | 512-714-4786
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Authorized Official
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Title or Position | OWNER
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Name | OLUBUSAYO K OBAYAN
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Credential | M.D.
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Telephone | 512-312-7552
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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 | Q5053
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License Number State | TX
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