OrganizationActive
Dermatology Center for Children & Young Adults PA
NPI 1053417055 · Pediatric Dermatology Physician · Eagan, MN
Provider details
- NPI number
- 1053417055
- Entity type
- Organization
- Primary specialty
- Pediatric Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kenneth Bloom, President(651) 379-9999
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2795 Pilot Knob Rd
Suite 300
Eagan, MN 55121-1176
Phone: (651) 379-9999
Fax: (651) 379-9900
Street-level locationGet directions
Mailing address
2795 Pilot Knob Rd
Eagan, MN 55121-1176
Registry dates
- Enumerated
- 2006-09-16
- Last updated
- 2008-04-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.