John Ewing Kiesselbach, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

CA24466 Issued in CA

Practice address

6000 Fairway Drive
Suite 10
Rocklin, CA 95677

Phone

(916) 632-5809

Fax

(916) 632-5814

NPI assigned

Oct 11, 2007

Last updated

Oct 11, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1093903312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 FAIRWAY DRIVE",
            "address_2": "SUITE 10",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95677",
            "telephone_number": "916-632-5809",
            "fax_number": "916-632-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 FAIRWAY DRIVE",
            "address_2": "SUITE 10",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95677",
            "telephone_number": "916-632-5809",
            "fax_number": "916-632-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIESSELBACH",
        "first_name": "JOHN",
        "middle_name": "EWING",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "CA24466",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "CA24466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole N Khatibi, PHARMD, RPH
• Kaitlin Khatri
• Dave Khuu, D.C
• Brian Kiefer, PHARMD
• Amy Marie Kiesselbach, D.D.S.
• Allison Nicole Thon Kiger
• Christine Nicole Kiley, OTR/L
• Hee Sook Kim, OT
• Joshua Y Kim, PHARMD
• Yoonah Park Kim

• Dentist in Rocklin, CA
• Providers in Rocklin, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.

Verify at the official NPI Registry.