NPIMap

Organization Active NPI

Penn, Kanaya, Dwelle, MD's

Doing business as Pediatric Group of Monterey

  • Pediatrics Physician
  • Monterey, CA
National Provider Identifier
1053417212
Registry record updated Jun 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PENN, KANAYA, DWELLE, MD'S
Doing business as
Pediatric Group of Monterey
Practice address
1900 Garden Rd Ste 110
Monterey, CA 93940-5334
Phone
(831) 372-5841
Fax
(831) 372-4820
NPI assigned
Sep 15, 2006
Last updated
Jun 25, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PENN, KANAYA, DWELLE, MD'SAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2010

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

Authorized official

Name
Kathie L Stark
Title
Executive Director
Phone
(831) 372-5841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1900 Garden Rd Ste 110
Monterey, CA 93940-5334

Mailing address

1900 Garden Rd
Suite 110
Monterey, CA 93940-5373
Phone (831) 372-5841

Other identifiers 1

IdentifierTypeStateIssuer
1053417212MedicaidCA

Other names 1

  • Pediatric Group of Monterey Doing business as

National Provider Directory

National Provider Directory
Part of
Branson Black Penn Engl

Locations

920 Cass St
Monterey, CA 93940
Phone (831) 372-5841

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1053417212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 GARDEN RD",
            "address_2": "SUITE 110",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939405373",
            "telephone_number": "831-372-5841",
            "fax_number": "831-372-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GARDEN RD STE 110",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939405334",
            "telephone_number": "831-372-5841",
            "fax_number": "831-372-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN, KANAYA, DWELLE, MD'S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN, KANAYA, DWELLE, MD'S",
        "enumeration_date": "2006-09-15",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "KATHIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "831-372-5841"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053417212",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Group of Monterey",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monterey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; 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.