Provider Demographics
NPI:1437982055
Name:KHROM MEDSPA & WELLNESS FL PA
Entity type:Organization
Organization Name:KHROM MEDSPA & WELLNESS FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-688-9677
Mailing Address - Street 1:12462 W ATLANTIC BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4086
Mailing Address - Country:US
Mailing Address - Phone:954-688-9677
Mailing Address - Fax:754-704-7285
Practice Address - Street 1:12462 W ATLANTIC BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4086
Practice Address - Country:US
Practice Address - Phone:954-688-9677
Practice Address - Fax:754-704-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty