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

Dermatology Center for Children & Young Adults PA

Organization Pediatric Dermatology Physician · NPI 1053417055

Dermatology Center for Children & Young Adults PA is a Pediatric Dermatology Physician in Eagan, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

2795 Pilot Knob Rd Ste 300
Eagan, MN 55121-1176
Phone: (651) 379-9999
Fax: (651) 379-9900
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dermatology Physician (primary) Taxonomy 207NP0225X (MN)

Record details

NPI number1053417055
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kenneth Bloom — President · (651) 379-9999
NPI enumeratedSeptember 16, 2006
Last updated in NPPESApril 20, 2008
Mailing address2795 Pilot Knob Rd, Suite 300, Eagan, MN 55121-1176