NPIMap

Organization Active NPI

Arizona Skin and Laser Therapy Institute, LLC

  • Dermatology Physician
  • Phoenix, AZ
National Provider Identifier
1790732832
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 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
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Authorized official

Name
William Ko, MDNPI 1841230976
Title
Managing Employee
Phone
(602) 277-1449

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X AZ Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2224 W Northern Ave
Ste D300
Phoenix, AZ 85021
Phone (602) 277-1449

2224 W Northern Ave
Ste D301
Phoenix, AZ 85021

4835 E Cactus Rd
Ste 155
Scottsdale, AZ 85254
Phone (602) 996-3050

4835 E Cactus Rd
Ste 620
Scottsdale, AZ 85254

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1790732832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 N CENTRAL EXPY STE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752310928",
            "telephone_number": "602-277-1449",
            "fax_number": "602-277-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 W NORTHERN AVE",
            "address_2": "SUITE D-300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214928",
            "telephone_number": "602-277-1449",
            "fax_number": "602-277-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SKIN AND LASER THERAPY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "MANAGING EMPLOYEE",
        "authorized_official_telephone_number": "602-277-1449",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.