Active NPI
Kenneth Joseph Fraga, DDS
- General Practice Dentistry
- Pleasant Hill, CA
National Provider Identifier
1013132604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 41174
- Practice address
- 401 Gregory LN
#222
Pleasant Hill, CA 94523 - Phone
- (925) 687-0343
- Fax
- (925) 687-4711
- NPI assigned
- Apr 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 41174 | CA | Primary |
Addresses
Primary practice location
401 Gregory LN
#222
Pleasant Hill, CA 94523
Mailing address
401 Gregory LN
#222
Pleasant Hill, CA 94523
Phone (925) 687-0343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41174 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013132604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 GREGORY LN",
"address_2": "#222",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "94523",
"telephone_number": "925-687-0343",
"fax_number": "925-687-4711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 GREGORY LN",
"address_2": "#222",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "94523",
"telephone_number": "925-687-0343",
"fax_number": "925-687-4711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRAGA",
"first_name": "KENNETH",
"middle_name": "JOSEPH",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "41174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Hill, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.