Kaely Kantaris

Primary specialty

DentistTaxonomy code 122300000X

License

DDS108191 Issued in CA

Practice address

4435 Eastgate Mall #125
San Diego, CA 92121-5191

Phone

(858) 546-7667

NPI assigned

Aug 18, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1408320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683417600000",
    "number": "1104225994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4565 48TH STREET",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 EASTGATE MALL #125",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921215191",
            "telephone_number": "858-546-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTARIS",
        "first_name": "KAELY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-18",
        "last_updated": "2023-05-07",
        "certification_date": "2023-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1000988-15",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27647",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS108191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dipul M. Kansagara, MD
• Leena R Kansal, M.D.
• Nikhil Kansal, M.D.
• Devanshu V. Kansara, M.D.
• Megan Kantara, LPC
• Deana A. Kantartzis, MD
• Ross Kanter, LMFT
• Simone Elise Kanter, M.D.
• Tina Huynh Kantharia, M.D.
• Ibolya M Kantor, PH.D.

• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2023; 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.