Individual provider Active NPI

Kenneth Edward Klassen, DDS

  • General Practice Dentistry
  • Clovis, CA
National Provider Identifier
1164547725
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DV31814 Issued in CA
Practice address
401 Clovis Ave Ste 203
Clovis, CA 93612-1182
Phone
(559) 299-9211
Fax
(559) 299-9215
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DV31814 CA Primary

Addresses

Primary practice location

401 Clovis Ave Ste 203
Clovis, CA 93612-1182

Mailing address

401 Clovis Ave Ste 203
Clovis, CA 93612-1182
Phone (559) 299-9211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DV31814CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164547725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CLOVIS AVE STE 203",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121182",
            "telephone_number": "559-299-9211",
            "fax_number": "559-299-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CLOVIS AVE STE 203",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121182",
            "telephone_number": "559-299-9211",
            "fax_number": "559-299-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLASSEN",
        "first_name": "KENNETH",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DV31814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

  • 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.