Kelsey Lomen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107961 Issued in CA

Practice address

4720 Elk Grove Blvd Ste 170
Elk Grove, CA 95758-4185

Phone

(916) 691-9191

NPI assigned

Jun 8, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Sireesha Penumetcha, DDS PC

  • Dental Clinic/Center
  • Elk Grove, CA
  • NPI 1861118580

  General Practice

  NPD

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1043887060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 ADDISON WAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412708",
            "telephone_number": "323-919-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 ELK GROVE BLVD STE 170",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957584185",
            "telephone_number": "916-691-9191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 Tiverton Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900958361",
            "country_code": "US",
            "telephone_number": "323-919-4219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOMEN",
        "first_name": "KELSEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klomen@g.ucla.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2130 Addison Way",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900412708",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "klomen@ucla.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "714 Tiverton Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900958361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• General Practice Dentistry in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.