MEDICARE: LK AESTHETICS AND DERMATOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1265363808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LK AESTHETICS AND DERMATOLOGY

Provider Business Mailing Address
First Line	:	907 N FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3224
Country	:	US
Telephone Number	:	561-292-3747
Fax Number	:	561-292-3730

Provider Business Practice Location Address
First Line	:	907 N FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3224
Country	:	US
Telephone Number	:	561-292-3747
Fax Number	:	561-292-3730

Authorized Official
Title or Position	:	OWNER
Name	:	LORRAINE KRYVICKY
Credential	:
Telephone Number	:	561-292-3730

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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