Individual
DR. KENNETH GARY GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5222 BALBOA AVE, SIXTH FLOOR, SAN DIEGO, CA 92117-6904
(858) 292-5101
(858) 292-0514
Mailing address
5222 BALBOA AVE, SIXTH FLOOR, SAN DIEGO, CA 92117-6904
(858) 292-5101
(858) 292-0514
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A37440
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A37440
CA
207NS0135X
Procedural Dermatology Physician
A37440
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A374400
—
CA
01
—
A37440
CA STATE LICENSE
CA
Enumeration date
06/06/2006
Last updated
05/05/2008
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