Aesthetica Medical Spa LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

432761 Issued in AK

Legal business name

AESTHETICA MEDICAL SPA LLC

Doing business as

Alaska Dermatology

Practice address

135 W Dimond Blvd Ste 104
Anchorage, AK 99515-1907

Phone

(907) 562-2275

Fax

(907) 563-7929

NPI assigned

Jun 11, 2006

Last updated

Mar 25, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Millen

Title

Owner

Phone

(907) 562-2275

Specialties & licenses 1

Addresses

Other names 1

• Alaska Dermatology Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven James Kilkenny, MD

  • Family Medicine Physician
  • Anchorage, AK
  • NPI 1871663179
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1154363752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WEST 34TH AVENUE PMB 1008",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995035650",
            "telephone_number": "907-350-9110",
            "fax_number": "907-563-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W DIMOND BLVD STE 104",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151907",
            "telephone_number": "907-562-2275",
            "fax_number": "907-563-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETICA MEDICAL SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "MILLEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-562-2275"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AK",
            "license": "432761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Anchorage",
            "affiliation": "N",
            "address_1": "135 W Dimond Blvd Ste 104",
            "city": "Anchorage",
            "state": "AK",
            "country_code": "US",
            "postal_code": "995151907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Alaska Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alaska Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Dermatology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.