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DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA
NPI 1053417055
Dermatology - Pediatric Dermatology in Eagan, MN

Active since September 16, 2006
2795 PILOT KNOB RD, SUITE 300, EAGAN, MN 55121(651) 379-9999(651) 379-9900 Get Directions Write a Review

NPPES record last updated: April 20, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dermatology Center For Children & Young Adults Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA (NPI 1053417055) is a healthcare organization registered as a pediatric dermatology in Eagan, Minnesota and active in the NPI registry since September 2006. The organization lists Kenneth E Bloom, President, as its authorized official.

NPPES Registry Identity

NPI1053417055
Entity TypeOrganization
Primary Taxonomy207NP0225X
Legal Business NameDERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA
Location Address2795 PILOT KNOB RD, SUITE 300Eagan, MN 55121-1176
Mailing Address2795 Pilot Knob Rd, Suite 300Eagan, MN 55121-1176 · (651) 379-9999 · Fax (651) 379-9900
Phone(651) 379-9999
Fax(651) 379-9900
Organization SubpartNo
Authorized OfficialKenneth E BloomPresident · (651) 379-9999
Enumeration DateSeptember 16, 2006
Last NPPES UpdateApril 20, 2008
✔ NPI 1053417055 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Pediatric DermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207NP0225X
Definition
A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents.
2795 PILOT KNOB RD, Eagan, MN 55121
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Other Identifiers 3

Other2M741DEBlue Cross Blue Shield
Medicaid013837ND
Medicare ID-Type UnspecifiedC04406MN · Medicare Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHEYLA VELAZQUEZ
Pharmacy Technician
2795 PILOT KNOB RD
EAGAN, MN 55121
Dakota County (651) 846-9245
CLAUDIA CHRISTENSEN-MAJOR MACCCSLP
Speech-Language Pathologist
2795 PILOT KNOB RD, SUITE 100
EAGAN, MN 55121
Dakota County (651) 994-9644
MRS. CATHERINE CLAIRE SCHWARTZ OTR/L
Occupational Therapist (Pediatrics)
2795 PILOT KNOB RD
EAGAN, MN 55121
Dakota County (651) 994-9644
KELLY CARLSON MACCCSLP
Speech-Language Pathologist
2795 PILOT KNOB RD, SUITE 100
EAGAN, MN 55121
Dakota County (651) 994-9644
JENNIFER BAILEY MACCCSLP
Speech-Language Pathologist
2795 PILOT KNOB RD, SUITE #100
EAGAN, MN 55121
Dakota County (651) 994-9644
ANNE ENDRIZZI OTRL
Occupational Therapist
2795 PILOT KNOB RD, SUITE 100
EAGAN, MN 55121
Dakota County (651) 994-9644
AMBER LYNN KAYE
Pharmacy Technician
2795 PILOT KNOB RD
EAGAN, MN 55121
Dakota County (651) 846-9245
MARISSA ANN FINUCANE
Pharmacy Technician
2795 PILOT KNOB RD
EAGAN, MN 55121
Dakota County (651) 846-9245

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Center For Children & Young Adults PA's NPI number?

The NPI number for Dermatology Center For Children & Young Adults PA is 1053417055. It was assigned to this organization in the NPPES registry on September 16, 2006.

Where is Dermatology Center For Children & Young Adults PA located?

Dermatology Center For Children & Young Adults PA is located at 2795 Pilot Knob Rd Suite 300, Eagan, MN 55121. The listed phone number is (651) 379-9999.

What is Dermatology Center For Children & Young Adults PA's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Pediatric Dermatology, with taxonomy code 207NP0225X.

When was this NPI record last updated?

The NPPES record for Dermatology Center For Children & Young Adults PA was last updated on April 20, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.