DR. KENNETH GARY GROSS (NPI# 1104865898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104865898 |
| Entity Type | Individual |
| Full Name | DR. KENNETH GARY GROSS |
| Credential | M.D. |
| Practice Address |
5222 Balboa Ave Sixth Floor San Diego CA 92117-6904 |
| Practice Telephone | 8582925101 |
| Practice Fax Number | 8582920514 |
| Mailing Telephone | 8582925101 |
| Mailing Fax Number | 8582920514 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-05-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | A37440 | CA | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
A37440 | CA | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
A37440 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CA STATE LICENSE | A37440 | 01 |
| CA | 00A374400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528587433 | Kenneth Gross | Counselor | 22765 Westheimer Pkwy, Katy, TX 77450-8675 | 2017-09-12 |
| 1205357886 | Kenneth Gross | Psychiatry & Neurology | 777 S Broad St Apt 412, Philadelphia, PA 19147-2509 | 2017-07-04 |
| 1740488709 | Kenneth M Gross | Chiropractor | 293 Passaic St, Passaic, NJ 07055-5803 | 2007-07-10 |
| 1831155969 | Kenneth M Gross | Internal Medicine | 904 7th Ave, Seattle, WA 98104-1132 | 2006-04-26 |
| 1730155938 | Kenneth P Gross | Anesthesiology | 2900 S 70th St Ste 450, Lincoln, NE 68506-3796 | 2006-02-27 |
| Street Address |
5222 BALBOA AVE SIXTH FLOOR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92117-6904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699772756 | Raymond C Heung | Internal Medicine | 5222 Balboa Ave, Ste 33, San Diego, CA 92117-6953 | 2005-07-05 |
| 1265851810 | Lindsay Lindsay Trottier | Acupuncturist | 5222 Balboa Ave, Suite 21, San Diego, CA 92117-6904 | 2014-04-10 |
| 1427499128 | Rty Pharmaceutical Inc | Pharmacy | 5222 Balboa Ave, San Diego, CA 92117-6904 | 2013-07-10 |
| 1215294244 | Erica Dawn Stark | Acupuncturist | 5222 Balboa Ave, Suite 43, San Diego, CA 92117-6904 | 2012-04-16 |
| 1447563275 | Jessica Davis | Nurse Practitioner | 5222 Balboa Ave, Suite 31, San Diego, CA 92117-6904 | 2010-07-21 |
| 1548441389 | Walter Jolley Dpm A Professional Corporation | Podiatrist | 5222 Balboa Ave, Suite 52, San Diego, CA 92117-6904 | 2007-11-20 |
| 1750570289 | Evelyn Jeehyun Kang | Chiropractor | 5222 Balboa Ave, Suite# 73, San Diego, CA 92117-6904 | 2007-10-22 |
| 1669699849 | Raymond Heung, M.d. | Clinical Medical Laboratory | 5222 Balboa Ave, Suite 33, San Diego, CA 92117-6904 | 2007-04-19 |
| 1538384573 | Mike Adams | Dentist | 5222 Balboa Ave, Suite 71, San Diego, CA 92117-6904 | 2007-04-16 |
| 1194898064 | Mahindokht Mary Raiszadeh | Legal Medicine | 5222 Balboa Ave, Ste 45, San Diego, CA 92117-6904 | 2006-11-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956050 | Enbara Corporation | Dentist | 5189 Clairmont Mesa Blvd, San Diego, CA 92117 | 2020-03-11 |
| 1568956050 | Lourdes C Villagran | Case Manager/Care Coordinator | 4474 Charger Blvd, San Diego, CA 92117 | 2018-06-18 |
| 1750893509 | Dzendzel Family Chiropractic | Chiropractor | 3650 Clairemont Drive, Ste 2, San Diego, CA 92117 | 2017-11-02 |
| 1205355401 | Alan Ford | Counselor | 4150 Ute Dr., San Diego, CA 92117 | 2017-09-19 |
| 1780101238 | Allison Dawn Heeney | Occupational Therapist | 3386 Hopi Place, San Diego, CA 92117 | 2017-08-25 |
| 1275074379 | Rachel Gabrielle Packer | Counselor | 5252 Balboa Ave Ste 801, San Diego, CA 92117 | 2017-03-09 |
| 1316482995 | Lisa Graff-marsh, Inc. | Social Worker | 4985 Park Rim Dr., San Diego, CA 92117 | 2017-01-05 |
| 1417408949 | Markos and Markos 1 Inc | Private Vehicle | 4495 Clairemont Mesa Blvd, San Diego, CA 92117 | 2016-10-19 |
| 1801341813 | Huynh and Habashi Dental Corporation | Dentist | 2995 Clairemont Dr, Suite A, San Diego, CA 92117 | 2016-08-19 |
| 1184076077 | Tammy Monck | Optometrist | 3952 Clairemont Mesa Blvd Ste I, San Diego, CA 92117 | 2016-07-05 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497399141 | Dermatology Specialists Inc | Dermatology | 4765 Carmel Mountain Rd Ste 201, San Diego, CA 92130-6657 | 2019-11-05 |
| 1306405998 | Mismo Dermatology Group Apc | Dermatology | 8898 Navajo Rd Ste C-349, San Diego, CA 92119-2141 | 2019-06-07 |
| 1609361740 | Seaver Soon Md Inc | Dermatology | 2044 W California St, San Diego, CA 92110-2121 | 2018-06-29 |
| 1700240249 | Alexandra Edelman | Dermatology | 3965 5th Ave Ste 200, San Diego, CA 92103-3107 | 2016-04-11 |
| 1033572391 | Lauren Metterle | Dermatology | 3020 Childrens Way # 5092, San Diego, CA 92123-4223 | 2016-04-03 |
| 1225493323 | Jeanette Jacknin | Dermatology | 12634 Carmel Country Rd, Suite 126, San Diego, CA 92130-3197 | 2015-12-16 |
| 1417330432 | Eugene Tachuk | Dermatology | 3740 Rosecrans St Ste C, San Diego, CA 92110-3126 | 2015-07-08 |
| 1508203563 | Monica Boen | Dermatology | 9339 Genesee Ave Ste 350, San Diego, CA 92121-2150 | 2013-05-31 |
| 1619311164 | David Otto Schairer | Dermatology | 8010 Frost St Ste 602, San Diego, CA 92123 | 2013-04-25 |
| 1295037760 | Susan Ann Kincaid | Dermatology | 1951 4th Ave Ste 202, San Diego, CA 92101-2374 | 2010-12-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.