Provider Demographics
NPI:1447496526
Name:SKINWISE DERMATOLOGY CLINIC, P.C.
Entity type:Organization
Organization Name:SKINWISE DERMATOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:ZHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-521-2645
Mailing Address - Street 1:1371 HECLA DR STE C2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2318
Mailing Address - Country:US
Mailing Address - Phone:303-427-0432
Mailing Address - Fax:855-504-1008
Practice Address - Street 1:1371 HECLA DR STE C2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2318
Practice Address - Country:US
Practice Address - Phone:303-427-0432
Practice Address - Fax:855-504-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59953241Medicaid
COI24993Medicare UPIN
CO800929Medicare PIN