NPIMap

Organization Active NPI

Dermatology & Cosmetic Surgery Associates PA

  • Specialist
  • Houston, TX
National Provider Identifier
1164859229
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K5639 Issued in TX
Legal business name
DERMATOLOGY & COSMETIC SURGERY ASSOCIATES PA
Doing business as
Lifeway Dermatology
Practice address
1001 West Loop S
Ste 813
Houston, TX 77027-9084
Phone
(713) 960-1311
Fax
(713) 960-1325
NPI assigned
Oct 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Authorized official

Name
Dr. Anthony Phan Nikko, MDNPI 1962649491
Title
President
Phone
(713) 960-1311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X K5639 TX Primary

Addresses

Primary practice location

1001 West Loop S
Ste 813
Houston, TX 77027-9084

Mailing address

1001 West Loop S
Ste 813
Houston, TX 77027-9084
Phone (713) 960-1311

Other names 1

  • Lifeway Dermatology Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1164859229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST LOOP S",
            "address_2": "STE 813",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770279084",
            "telephone_number": "713-960-1311",
            "fax_number": "713-960-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WEST LOOP S",
            "address_2": "STE 813",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770279084",
            "telephone_number": "713-960-1311",
            "fax_number": "713-960-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & COSMETIC SURGERY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "NIKKO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "PHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-960-1311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "K5639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeway Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.