Jessica Kwon

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

101510 Issued in CA

Practice address

1643 S San Jacinto Ave Ste a
San Jacinto, CA 92583-5181

Phone

(951) 654-7744

NPI assigned

Jul 6, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kinder Smiles Pediatric Dentistry

  • Pediatric Dentistry
  • Parker, CO
  • NPI 1689486680
  NPD Authorized official
• Ellen Im DDS Inc

  • Pediatric Dentistry
  • Poway, CA
  • NPI 1861091720
  NPD (past)
• Larina Chu,DDS Inc.

  • Pediatric Dentistry
  • Apple Valley, CA
  • NPI 1710347521
  NPD (past)
• Lee and Nosti Dental Corporation

  • General Practice Dentistry
  • San Jacinto, CA
  • NPI 1033385455
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1043731433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 S ASH ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 S SAN JACINTO AVE STE A",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835181",
            "telephone_number": "951-654-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWON",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "101510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Koh, R.D.
• Larae Kreitz
• Jeffrey Michael Kruger
• Juli Anne Kukulka, CAS II
• Nina Kumar, FNP
• La Vista Inc
• Anna Lissa S Ladiero
• Terri P Lafountain
• Melissa Larrabee, RMA
• Elizabeth Claire Lauron, D.D.S.

• Pediatric Dentistry in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.