Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blue Valley Dermatology LLC

Organization Dermatology Physician · NPI 1104354794

Blue Valley Dermatology LLC is a Dermatology Physician in Overland Park, Kansas. Works from 2 locations. Licensed in Kansas.

Licensed in
KS
In the registry since
2017
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

7840 W 165th St Ste 260
Overland Park, KS 66223
Phone: (415) 802-1310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7520 W 160th St Ste 100, Overland Park, KS 66085-8137 — (913) 871-8221

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 04-36968 (KS)

Record details

NPI number1104354794
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tom Tkachuk — Manager · (415) 802-1310
NPI enumeratedMay 26, 2017
Last updated in NPPESOctober 25, 2021
Certification dateOctober 25, 2021
Mailing address7840 W 165th Street, Suite 260, Overland Park, KS 66223

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