Active NPI
Kelly Marie Kidon, DDS
- Dentist
- Ventura, CA
National Provider Identifier
1063810661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 64263
- Practice address
- 4744 Telephone Rd
Ventura, CA 93003-5244 - Phone
- (805) 653-0620
- NPI assigned
- Dec 12, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 64263 | CA | Primary |
Addresses
Primary practice location
4744 Telephone Rd
Ventura, CA 93003-5244
Mailing address
4744 Telephone Rd
Ventura, CA 93003-5244
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 |
|---|---|---|---|
| 64263 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465862400000",
"number": "1063810661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4744 TELEPHONE RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930035244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4744 TELEPHONE RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930035244",
"telephone_number": "805-653-0620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDON",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-12",
"last_updated": "2016-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "64263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.