Pure Dermatology Center

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

P7657 Issued in TX

Legal business name

PURE DERMATOLOGY CENTER

Practice address

2005 West Park Drive, Suite 120
Irving, TX 75061

Phone

(972) 827-1130

Fax

(972) 597-4290

NPI assigned

Dec 28, 2016

Organization subpart

No

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

Authorized official

Name

Carolyn KimNPI 1063594299

Title

Owner/Medical Doctor

Phone

(972) 827-1130

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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

• Carolyn Kim, MD

  • Dermatology Physician
  • Irving, TX
  • NPI 1063594299
  Medicare reassignment Care Compare group NPD Authorized official
• Mai Kim Thi Nguyen, PA

  • Physician Assistant
  • Dallas, TX
  • NPI 1255791323
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565049600000",
    "number": "1851836928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 W PARK DR STE 120",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750612034",
            "telephone_number": "972-827-1130",
            "fax_number": "972-597-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 WEST PARK DRIVE, SUITE 120",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "75061",
            "telephone_number": "972-827-1130",
            "fax_number": "972-597-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE DERMATOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2019-08-06",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OWNER/MEDICAL DOCTOR",
        "authorized_official_telephone_number": "972-827-1130"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "P7657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna J Pulley, SLP-A
• Michael Gene Puls
• Jheel Kiran Punmia, PT
• Purani Inc
• Michael Joseph Purcell, PH.D.
• Margaret Puyat, BCABA 0-22-14226
• Q T Home Health Corporation
• Q T Medical Supplies Corporation
• Qevix LLC
• Amena Qirba, PHARMACY

• Dermatology Physician in Irving, TX
• Providers in Irving, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.