Jerry Lee Kronquist, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30388 Issued in CA

Practice address

1906 N . Broadway
Santa Ana, CA 92706-2610

Phone

(714) 547-6671

Fax

(714) 547-4385

NPI assigned

May 10, 2007

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1114132636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 N BROADWAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927062610",
            "telephone_number": "714-547-6671",
            "fax_number": "714-547-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 N . BROADWAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927062610",
            "telephone_number": "714-547-6671",
            "fax_number": "714-547-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRONQUIST",
        "first_name": "JERRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30388",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "30388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Kring
• Krishan S. Khurana MD, Inc.
• Alexis Susanna Kroes
• Kathryn Kromminga, RN
• Amanda Rae Kronquist, D.D.S.
• Zakary Adam Kronquist
• Andrew D Kruckeberg, BSE
• Christine Krueger, PPS
• Christopher Michael Krueger
• Kelly Don Krueger, PSYD

• Oral and Maxillofacial Surgery (Dentist) in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.