Active NPI
Kathleen Ann Gordon, DDS
- General Practice Dentistry
- Riverside, CA
National Provider Identifier
1184704587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 42655
- Practice address
- 4515 Central Ave Ste 103
Riverside, CA 92506-2374 - Phone
- (951) 682-0042
- Fax
- (951) 682-0043
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 42655 | CA | Primary |
Addresses
Primary practice location
4515 Central Ave Ste 103
Riverside, CA 92506-2374
Mailing address
3955 Rice Rd
Riverside, CA 92506-0143
Phone (951) 682-0042
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42655 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184704587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3955 RICE RD",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925060143",
"telephone_number": "951-682-0042",
"fax_number": "951-682-0043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 CENTRAL AVE STE 103",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925062374",
"telephone_number": "951-682-0042",
"fax_number": "951-682-0043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "42655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, 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.