Stephan Antonius Kohnen, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DDS107483 Issued in CA

Practice address

27757 Aspel Rd Apt 923
Menifee, CA 92585-7707

Phone

(832) 514-5578

NPI assigned

May 22, 2012

Last updated

Sep 29, 2023By 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

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.

Opted out of Medicare

Yes, effective Dec 12, 2022 through Dec 12, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Implant & Periodontic Specialists

  • Periodontics
  • Bellevue, WA
  • NPI 1225445539
  NPD (past)
• Neal C Raval DDS MSD PS Inc

  • Periodontics
  • Bellevue, WA
  • NPI 1356768774
  NPD (past)

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1154681385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27757 ASPEL RD APT 923",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925857707",
            "telephone_number": "832-514-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27757 ASPEL RD APT 923",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925857707",
            "telephone_number": "832-514-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHNEN",
        "first_name": "STEPHAN",
        "middle_name": "ANTONIUS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "22471",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "DDS107483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Kirk, PA-C
• Lashawn Klos, LMFT
• Anthony Knott
• Lindsay Koellen
• Diana Suzanne Koenen, MA
• Raymond Komosinski I, B.S. PHARMACY
• Colleen Koon
• Benjamin Koppel, DDS
• Grzegorz Korzeniowski
• Cheyenne Kouy

• Periodontics in Menifee, CA
• Providers in Menifee, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.