NPIMap

Organization Active NPI

Coastal Family Dermatology, PC

  • Pediatric Dermatology Physician
  • San Luis Obispo, CA
National Provider Identifier
1174927073
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
A72400 Issued in CA
Legal business name
COASTAL FAMILY DERMATOLOGY, PC
Practice address
892 Aerovista PL Ste 120
San Luis Obispo, CA 93401-8054
Phone
(805) 544-5567
Fax
(805) 544-3265
NPI assigned
Oct 21, 2014
Last updated
Jul 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Authorized official

Name
Christine Denise Kilcline, M.D.NPI 1093724791
Title
M.D./Owner
Phone
(805) 544-5567

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dermatology Physician 207NP0225X A72400 CA Primary
Procedural Dermatology Physician 207NS0135X A72400 CA

Addresses

Primary practice location

892 Aerovista PL Ste 120
San Luis Obispo, CA 93401-8054

Mailing address

892 Aerovista PL Ste 120
San Luis Obispo, CA 93401-8054
Phone (805) 544-5567

Other practice location 1

525 Plaza Dr Ste 200
Santa Maria, CA 93454-6954
Phone (805) 544-5567

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150302001308 CA Part B Supplier - Clinic/Group Practice 3678899051 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: San Luis Obispo, CA; Santa Maria, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1174927073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 AEROVISTA PL STE 120",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934018054",
            "telephone_number": "805-544-5567",
            "fax_number": "805-544-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "892 AEROVISTA PL STE 120",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934018054",
            "telephone_number": "805-544-5567",
            "fax_number": "805-544-3265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 Plaza Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934546954",
            "country_code": "US",
            "telephone_number": "805-544-5567",
            "fax_number": "805-544-3265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL FAMILY DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "KILCLINE",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "M.D./OWNER",
        "authorized_official_telephone_number": "805-544-5567",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "A72400",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A72400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.