Organization
SKIN SURGERY MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH GARY GROSS M.D. (PRESIDENT)
(858) 292-5101
Entity
Organization
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
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0069330
—
CA
Enumeration date
05/24/2006
Last updated
05/05/2008
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