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SKIN SURGERY MEDICAL GROUP INC.
NPI 1659326957
Dermatology in San Diego, CA

Active since May 24, 2006CLIA 05D0570880 · Certificate of Compliance
5222 BALBOA AVE, SIXTH FLOOR, SAN DIEGO, CA 92117(858) 292-5101(858) 292-0514 Get Directions Write a Review

NPPES record last updated: May 5, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Skin Surgery Medical Group Inc. NPPES

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

SKIN SURGERY MEDICAL GROUP INC. (NPI 1659326957) is a healthcare organization registered as a dermatology in San Diego, California and active in the NPI registry since May 2006. The organization holds a CLIA Certificate of Compliance certificate valid through September 28, 2027 and lists Kenneth Gary Gross, President, as its authorized official.

NPPES Registry Identity

NPI1659326957
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSKIN SURGERY MEDICAL GROUP INC.
Location Address5222 BALBOA AVE, SIXTH FLOORSan Diego, CA 92117-6904
Mailing Address5222 Balboa Ave, Sixth FloorSan Diego, CA 92117-6904 · (858) 292-5101 · Fax (858) 292-0514
Phone(858) 292-5101
Fax(858) 292-0514
Organization SubpartNo
Authorized OfficialKenneth Gary GrossPresident · (858) 292-5101
Enumeration DateMay 24, 2006
Last NPPES UpdateMay 5, 2008
✔ NPI 1659326957 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
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.
5222 BALBOA AVE, San Diego, CA 92117
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Other Identifiers 2

Medicare PINW10324CA
MedicaidGR0069330CA

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

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 05D0570880

Skin Surgery Medical Group Inc · San Diego, CA
Active · expires Sep 28, 2027
CLIA Number05D0570880
Laboratory TypePhysician Office
Certificate Effective DateSeptember 29, 2025
Certificate Expiration DateSeptember 28, 2027
Laboratory DirectorAnne K. Truitt MD
Laboratory Phone(858) 292-5101
Laboratory LocationSkin Surgery Medical Group Inc16918 Dove Canyon Rd Ste 102, San Diego, CA 92127
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 15

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

DR. LESLIE ALISON MARK M.D.
Dermatology
5222 BALBOA AVE, SIXTH FLOOR
SAN DIEGO, CA 92117
San Diego County (858) 292-0204
DR. BARBARA ELAINE MARTIN M.D.
Dermatology
5222 BALBOA AVE, FIFTH FLOOR
SAN DIEGO, CA 92117
San Diego County (858) 292-7928
DR. KENNETH GARY GROSS M.D.
Dermatology
5222 BALBOA AVE, SIXTH FLOOR
SAN DIEGO, CA 92117
San Diego County (858) 292-5101
DR. MAHINDOKHT MARY RAISZADEH M.D.
Legal Medicine
5222 BALBOA AVE, STE 45
SAN DIEGO, CA 92117
San Diego County (858) 616-6430
ERICA DAWN STARK L.AC.
Acupuncturist
5222 BALBOA AVE, SUITE 43
SAN DIEGO, CA 92117
San Diego County (858) 568-2189
DR. WALTER HAROLD JOLLEY D.P.M.
Podiatrist (Foot & Ankle Surgery)
5222 BALBOA AVE, SUITE 52
SAN DIEGO, CA 92117
San Diego County (858) 560-0390
RTY PHARMACEUTICAL INC
Pharmacy (Specialty Pharmacy)
5222 BALBOA AVE
SAN DIEGO, CA 92117
San Diego County (858) 278-0111
DR. DALE EDWARD MARTIN M.D.
Dermatology
5222 BALBOA AVE, SIXTH FLOOR
SAN DIEGO, CA 92117
San Diego County (858) 292-5101

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 Skin Surgery Medical Group Inc.'s NPI number?

The NPI number for Skin Surgery Medical Group Inc. is 1659326957. It was assigned to this organization in the NPPES registry on May 24, 2006.

Where is Skin Surgery Medical Group Inc. located?

Skin Surgery Medical Group Inc. is located at 5222 Balboa Ave Sixth Floor, San Diego, CA 92117. The listed phone number is (858) 292-5101.

What is Skin Surgery Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Skin Surgery Medical Group Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D0570880) is associated with this NPI, valid through September 28, 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 Skin Surgery Medical Group Inc. was last updated on May 5, 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.