Dale A Kooistra, M.D., PHD.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G55734 Issued in CA

Practice address

15525 Pomerado Rd
Suite D2
Poway, CA 92064-2435

Phone

(858) 675-8001

Fax

(858) 487-1337

NPI assigned

Aug 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Stanford University School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rishu Gupta MD IncGroup PAC ID 8628424413, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

Practice roles

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Narat John Eungdamrong, M.D., PH.D.

  • Dermatology Physician
  • Del Mar, CA
  • NPI 1245548700
  Medicare reassignment
• Rishu Gupta, M.D.

  • Dermatology Physician
  • Vista, CA
  • NPI 1942620869
  Medicare reassignment
• Clayton T Hinshaw, MD

  • Procedural Dermatology Physician
  • Simi Valley, CA
  • NPI 1326043456
  Medicare reassignment
• Swati Kannan, M.D.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1508155227
  Medicare reassignment
• Howard A. Kurshenbaum, MD

  • Dermatology Physician
  • San Diego, CA
  • NPI 1538217476
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rishu Gupta MD Inc

  • Dermatology Physician
  • Poway, CA
  • NPI 1902519986
  Medicare reassignment Care Compare group NPD
• Palomar Health

  • General Acute Care Hospital
  • Escondido, CA
  • NPI 1457321317
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1831182971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE D2",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "858-675-8001",
            "fax_number": "858-487-1337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE D2",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "858-675-8001",
            "fax_number": "858-487-1337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOISTRA",
        "first_name": "DALE",
        "middle_name": "A",
        "credential": "M.D., PHD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G55734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G557340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Lloyd Kohler, DMD
• Lindsay Marie Koller, PT
• Jacob Konechne
• Larry T Konzen
• Ivy Koo
• Jessica Anne Kraker, M.S., CF-SLP
• Lea Catherine Kravis
• Kenneth Melbourne Kroll, M.D.
• Michael Wayne Kruse, PHARM.D.
• Karen Kubischta, RDHAP

• Dermatology Physician in Poway, CA
• Providers in Poway, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.