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General NPI Number Information
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NPI Number | 1710842661
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Entity Type | Organization
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Legal Business Name | PACIFIC SKIN INSTITUTE
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 69-201 WAIKOLOA BEACH DR STE 2F-13
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City | WAIKOLOA
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State | HI
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Zip | 96738-5810
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Country | US
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Telephone | 916-925-7020
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Fax | 916-925-3680
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Provider Business Mailing Address
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Address Line | 1495 RIVER PARK DR STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95815-4517
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Country | US
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Telephone | 916-925-6950
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Fax | 916-925-3680
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEVIN YEN
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Credential |
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Telephone | 916-925-6950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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