R Glenn Kitasoe, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29329 Issued in CA

Practice address

825 Oak Grove Ave
C-501
Menlo Park, CA 94025-4434

Phone

(650) 323-5211

NPI assigned

Apr 17, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124244611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 OAK GROVE AVE",
            "address_2": "C-501",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254434",
            "telephone_number": "650-323-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 OAK GROVE AVE",
            "address_2": "C-501",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254434",
            "telephone_number": "650-323-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITASOE",
        "first_name": "R",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "29329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Kimerling, PH.D.
• Kathryn Kinasz, MD
• Ellen J King, AU.D.
• Barbara Kinsey, MFT
• Kyle Kitasoe
• Christopher Kite, PT
• Paul Jacob Kivelson, AMFT
• Kizzy Raphael, ND
• Peter A Klein, PH D
• Aurel Kleinerman, M.D., PH.D.

• General Practice Dentistry in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.