Active NPI
Kenneth Gary Gross, M.D.
- Dermatology Physician
- San Diego, CA
National Provider Identifier
1104865898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- A37440
- Practice address
- 5222 Balboa Ave
Sixth Floor
San Diego, CA 92117-6904 - Phone
- (858) 292-5101
- Fax
- (858) 292-0514
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| MOHS-Micrographic Surgery Physician | 207ND0101X | A37440 | CA | |
| Procedural Dermatology Physician | 207NS0135X | A37440 | CA | |
| Dermatology Physician | 207N00000X | A37440 | CA | Primary |
Addresses
Primary practice location
5222 Balboa Ave
Sixth Floor
San Diego, CA 92117-6904
Mailing address
5222 Balboa Ave
Sixth Floor
San Diego, CA 92117-6904
Phone (858) 292-5101
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A374400 | Medicaid | CA | |
| A37440 | Other | CA | CA STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A37440 | CA | MD | Procedural Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1104865898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5222 BALBOA AVE",
"address_2": "SIXTH FLOOR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176904",
"telephone_number": "858-292-5101",
"fax_number": "858-292-0514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5222 BALBOA AVE",
"address_2": "SIXTH FLOOR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176904",
"telephone_number": "858-292-5101",
"fax_number": "858-292-0514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "KENNETH",
"middle_name": "GARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "CA",
"license": "A37440",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "CA",
"license": "A37440",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "A37440",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A374400",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA STATE LICENSE",
"identifier": "A37440",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.