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GRACE DERMATOLOGY
NPI 1467231811
Clinic/Center - Medical Specialty in Los Alamitos, CA

Active since September 25, 2023CLIA 05D2320416 · Waiver
5122 KATELLA AVE, LOS ALAMITOS, CA 90720(562) 340-5566 Get Directions Write a Review

NPPES record last updated: September 25, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Grace Dermatology NPPES

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

GRACE DERMATOLOGY (NPI 1467231811) is a healthcare organization registered as a medical specialty in Los Alamitos, California and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through March 17, 2027 and lists Lina Kennedy, Ceo, as its authorized official.

NPPES Registry Identity

NPI1467231811
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameGRACE DERMATOLOGY
Location Address5122 KATELLA AVELos Alamitos, CA 90720-2826
Mailing Address4981 Myra AveCypress, CA 90630-4335 · (310) 430-8442
Phone(562) 340-5566
Organization SubpartNo
Authorized OfficialLina KennedyCeo · (310) 430-8442
Enumeration DateSeptember 25, 2023
NPPES CertifiedSeptember 25, 2023
✔ NPI 1467231811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
5122 KATELLA AVE, Los Alamitos, CA 90720
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Grace Dermatology 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 Grace Dermatology, which bills Medicare for the services this clinician delivers.

Clinician (1)

Lina Kennedy, M.D.
Dermatology
NPI 1467719260
2121 E COAST HWY STE 280
Corona Del Mar, CA 92625
(949) 688-1288
✔ PECOS✔ Accepts Medicare17 mi

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 Waiver 05D2320416

Grace Dermatology · Los Alamitos, CA
Active · expires Mar 17, 2027
CLIA Number05D2320416
Laboratory TypePhysician Office
Certificate Effective DateMarch 18, 2025
Certificate Expiration DateMarch 17, 2027
Laboratory DirectorLina J. Kennedy
Laboratory Phone(562) 502-7144
Laboratory LocationGrace Dermatology5122 Katella Ave, Suite 307, Los Alamitos, CA 90720
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Grace Dermatology's NPI number?

The NPI number for Grace Dermatology is 1467231811. It was assigned to this organization in the NPPES registry on September 25, 2023.

Where is Grace Dermatology located?

Grace Dermatology is located at 5122 Katella Ave, Los Alamitos, CA 90720. The listed phone number is (562) 340-5566.

What is Grace Dermatology's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Is Grace Dermatology enrolled in Medicare?

Yes. Grace Dermatology is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Grace Dermatology?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Grace Dermatology. 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 Grace Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2320416) is associated with this NPI, valid through March 17, 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 Grace Dermatology was last updated on September 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.