Arizona Skin and Laser Therapy Institute, LLC
Organization Active NPI Dermatology Physician · Phoenix, AZ
NPI 1790732832 · NPPES record last updated Oct 21, 2025
Key facts
- NPI
- 1790732832
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ARIZONA SKIN AND LASER THERAPY INSTITUTE, LLC
- Practice address
- 2224 W Northern Ave
Suite D-300
Phoenix, AZ 85021-4928 - Phone
- (602) 277-1449
- Fax
- (602) 277-9984
- NPI assigned
- May 27, 2006
- Organization subpart
- No
Authorized official
- Name
- William Ko, MD
- Title
- Managing Employee
- Phone
- (602) 277-1449
Other NPIs on the same Medicare enrollment 9
Practitioners 3
-
Richard Philip Levy, M.D., PH.D.
-
Marlene Wright, FNP
-
Karla M. Horton, P.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000424 | AZ | Part B Supplier - Clinic/Group Practice | 6204720626 |
Receives reassigned benefits from 17 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ |
National Provider Directory
Locations
4001 E Baseline Rd
Ste B8
Gilbert, AZ 85234
Phone (480) 844-0510
2224 W Northern Ave
Ste D301
Phoenix, AZ 85021
4835 E Cactus Rd
Ste 620
Scottsdale, AZ 85254
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | AZ | Yes |
Addresses
Primary practice location
2224 W Northern Ave
Suite D-300
Phoenix, AZ 85021-4928
Mailing address
9900 N Central Expy Ste 500
Dallas, TX 75231-0928
Phone (602) 277-1449
Other providers in Phoenix, AZ
- Arizona S Advanced Wound Care LLC
- Arizona Senior Life LLC
- Arizona Serenity Home Care LLC
- Arizona Sinus and ENT Associates PC
- Arizona Skin and Laser Therapy Institue, LTD
- Arizona Skin and Laser Therapy Institute, LTD
- Arizona Skin Specialists Dermatology, LLC
- Arizona Skin Specialists PLLC
- Arizona Sleep Centers
- Arizona Sonography Group Inc.
All providers in Phoenix, AZ · Dermatology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.