Kelli K Kanemaru-Takeuchi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

HAD49 Issued in FL

Practice address

480 W Lowder St
Macclenny, FL 32063-2664

Phone

(904) 259-6291

Fax

(904) 259-1950

NPI assigned

Aug 13, 2012

Last updated

Aug 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1255688933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 W LOWDER ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632664",
            "telephone_number": "904-259-6291",
            "fax_number": "904-259-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 W LOWDER ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632664",
            "telephone_number": "904-259-6291",
            "fax_number": "904-259-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANEMARU-TAKEUCHI",
        "first_name": "KELLI",
        "middle_name": "K",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "HAD49",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Assi, MD, PA (Children's Health Associates)
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• Josue Jorge Caraballo, M.D.
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• Steve Logan Kish, DPT
• Kla Enterprises, LLC Dba Luxe Health & Wellness
• Kyle Monroe Knabb, DO
• Sergio M Lagman, M.D.

• General Practice Dentistry in Macclenny, FL
• Providers in Macclenny, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.

Verify at the official NPI Registry.