Active NPI
Kelly Kim Nguyen, DDS
- Dentist
- Pittsburg, CA
National Provider Identifier
1235635418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104047
- Practice address
- 339 E Leland Rd
Pittsburg, CA 94565-4911 - Phone
- (925) 431-1250
- NPI assigned
- Apr 5, 2018
- Last updated
- Aug 21, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 104047 | CA | Primary |
Addresses
Primary practice location
339 E Leland Rd
Pittsburg, CA 94565-4911
Mailing address
337 E Leland Rd
Pittsburg, CA 94565-4911
Phone (925) 431-1250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190910003716 | CA | Order and Referring Only - Dentist | 7618206012 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LMC Dental | Dentist | Past | Accepting new patients |
| La Clinica de la Raza Inc | Past | Accepting new patients | |
| La Clinica de la Raza Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba La Clinica Dental at Children's Hospital Oakland
- Federally Qualified Health Center (FQHC)
- Oakland, CA
- NPI 1346262292
-
dba La Clinica Pittsburg Dental
- Federally Qualified Health Center (FQHC)
- Pittsburg, CA
- NPI 1528080470
-
- Dentist
- Pittsburg, CA
- NPI 1154772655
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566345600000",
"number": "1235635418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "337 E LELAND RD",
"city": "PITTSBURG",
"state": "CA",
"postal_code": "945654911",
"telephone_number": "925-431-1250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "339 E LELAND RD",
"city": "PITTSBURG",
"state": "CA",
"postal_code": "945654911",
"telephone_number": "925-431-1250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "KELLY",
"middle_name": "KIM",
"name_prefix": "Miss",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-05",
"last_updated": "2019-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.