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GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC
NPI 1053957456
Dermatology - MOHS-Micrographic Surgery in Mission Viejo, CA

Active since November 20, 2019CLIA 05D2182444 · Certificate of Compliance
26732 CROWN VALLEY PKWY STE 571, MISSION VIEJO, CA 92691(270) 933-2109 Get Directions Write a Review

NPPES record last updated: March 27, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 27, 2020, Nov 20, 2019 (2 updates tracked since 2019).

About Golden Coast Dermatology, Skin Cancer And Vein Center Pc NPPES

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

GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC (NPI 1053957456) is a healthcare organization registered as a mohs-micrographic surgery in Mission Viejo, California and active in the NPI registry since November 2019. The organization holds a CLIA Certificate of Compliance certificate valid through September 8, 2027 and lists William Tidwell, Owner/physician, as its authorized official.

NPPES Registry Identity

NPI1053957456
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameGOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC
Location Address26732 CROWN VALLEY PKWY STE 571Mission Viejo, CA 92691-7305
Mailing Address26732 Crown Valley Pkwy Ste 571Mission Viejo, CA 92691-7305 · (270) 933-2109
Phone(270) 933-2109
Organization SubpartNo
Authorized OfficialWilliam TidwellOwner/physician · (270) 933-2109
Enumeration DateNovember 20, 2019
Last NPPES UpdateMarch 27, 20202 updates tracked since enumeration
NPPES CertifiedMarch 27, 2020
✔ NPI 1053957456 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
26732 CROWN VALLEY PKWY STE 571, Mission Viejo, CA 92691
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Other Identifiers 1

OtherA147575CA · Ca State License

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Golden Coast Dermatology, Skin Cancer And Vein Center Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Golden Coast Dermatology, Skin Cancer And Vein Center PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jessica Kim, D.O.
Dermatology
NPI 1245663228
26732 CROWN VALLEY PKWY STE 571
Mission Viejo, CA 92691
(949) 200-7008
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D2182444

Golden Coast Dermatology, Skin Cancer & Vein Center PC · Mission Viejo, CA
Active · expires Sep 8, 2027
CLIA Number05D2182444
Laboratory TypePhysician Office
Certificate Effective DateSeptember 9, 2025
Certificate Expiration DateSeptember 8, 2027
Laboratory DirectorDr. Jessica Y. Kim
Laboratory Phone(949) 200-7008
Laboratory LocationGolden Coast Dermatology, Skin Cancer & Vein Center PC26732 Crown Valley Pkwy, Ste 571, Mission Viejo, CA 92691
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Golden Coast Dermatology, Skin Cancer And Vein Center PC's NPI number?

The NPI number for Golden Coast Dermatology, Skin Cancer And Vein Center PC is 1053957456. It was assigned to this organization in the NPPES registry on November 20, 2019.

Where is Golden Coast Dermatology, Skin Cancer And Vein Center PC located?

Golden Coast Dermatology, Skin Cancer And Vein Center PC is located at 26732 Crown Valley Pkwy Ste 571, Mission Viejo, CA 92691. The listed phone number is (270) 933-2109.

What is Golden Coast Dermatology, Skin Cancer And Vein Center PC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Golden Coast Dermatology, Skin Cancer And Vein Center PC enrolled in Medicare?

Yes. Golden Coast Dermatology, Skin Cancer And Vein Center PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Golden Coast Dermatology, Skin Cancer And Vein Center PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Golden Coast Dermatology, Skin Cancer And Vein Center PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Golden Coast Dermatology, Skin Cancer And Vein Center PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D2182444) is associated with this NPI, valid through September 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Golden Coast Dermatology, Skin Cancer And Vein Center PC was last updated on March 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.