NPIMap

Organization Active NPI

Kenneth P Dizon D.O Inc

  • Cardiovascular Disease Physician
  • Barstow, CA
National Provider Identifier
1154839561
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
20A15716 Issued in CA
Legal business name
KENNETH P DIZON D.O INC
Practice address
930 W Main St
Barstow, CA 92311-2654
Phone
(760) 256-1004
Fax
(760) 256-1055
NPI assigned
Jan 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Kenneth P Dizon, DO
Title
Ceo/President
Phone
(760) 256-1004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 20A15716 CA Primary

Addresses

Primary practice location

930 W Main St
Barstow, CA 92311-2654

Mailing address

930 W Main St
Barstow, CA 92311-2654
Phone (760) 256-1004

Other practice location 1

121 S 7th Ave
Barstow, CA 92311-3058
Phone (760) 256-1004

Other identifiers 1

IdentifierTypeStateIssuer
930OtherCAPERSONAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1154839561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 W MAIN ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112654",
            "telephone_number": "760-256-1004",
            "fax_number": "760-256-1055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 W MAIN ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112654",
            "telephone_number": "760-256-1004",
            "fax_number": "760-256-1055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 S 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Barstow",
            "state": "CA",
            "postal_code": "923113058",
            "country_code": "US",
            "telephone_number": "760-256-1004",
            "fax_number": "760-256-1055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENNETH P DIZON D.O INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "DIZON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "760-256-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "20A15716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL",
            "identifier": "930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barstow, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.