Skin Surgery Medical Group Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SKIN SURGERY MEDICAL GROUP INC.

Practice address

5222 Balboa Ave
Sixth Floor
San Diego, CA 92117-6904

Phone

(858) 292-5101

Fax

(858) 292-0514

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Gary Gross, M.D.

Title

President

Phone

(858) 292-5101

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1659326957",
    "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": {
        "organization_name": "SKIN SURGERY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-292-5101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0069330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shabina Lallani Skiles, LCSW
• Skilled Hartfield LLC
• Chase Brian Skillin, DO
• Courtney Leigh Skillman
• Skin Surgery and Aesthetic Dermatology
• Isabel Skinner
• Magdalene Elizabeth Skinner, BSW
• Nicole Jacaruso Skinner, PT
• Richard William Skinner, DO
• Taylor McKenzie Skinner

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• 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.

Verify at the official NPI Registry.