MEDICARE: PACIFIC SKIN INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1790649135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC SKIN INSTITUTE

Provider Business Mailing Address
First Line	:	1495 RIVER PARK DR STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4517
Country	:	US
Telephone Number	:	916-925-6950
Fax Number	:	916-925-3680

Provider Business Practice Location Address
First Line	:	69-201 WAIKOLOA BEACH DR STE 2F-13
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5810
Country	:	US
Telephone Number	:	808-500-0404
Fax Number	:	808-867-8985

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KEVIN YEN
Credential	:
Telephone Number	:	916-925-6950

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “PACIFIC SKIN INSTITUTE ” Practice Location

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