NPIMap

Organization Active NPI

Kanoknuch Shiflett Dental Corp

  • Pediatric Dentistry
  • West Covina, CA
National Provider Identifier
1295215168
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
40303 Issued in CA
Legal business name
KANOKNUCH SHIFLETT DENTAL CORP
Practice address
906 S Sunset Ave Ste 105
West Covina, CA 91790-3400
Phone
(626) 480-1543
Fax
(626) 480-0622
NPI assigned
Aug 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Dr. Kanoknuch Shiflett, DDSNPI 1609873876
Title
Ceo
Phone
(626) 991-3544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 40303 CA Primary

Addresses

Primary practice location

906 S Sunset Ave Ste 105
West Covina, CA 91790-3400

Mailing address

906 S Sunset Ave Ste 105
West Covina, CA 91790-3400
Phone (626) 480-1543

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": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1295215168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 S SUNSET AVE STE 105",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903400",
            "telephone_number": "626-480-1543",
            "fax_number": "626-480-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 S SUNSET AVE STE 105",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903400",
            "telephone_number": "626-480-1543",
            "fax_number": "626-480-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANOKNUCH SHIFLETT DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SHIFLETT",
        "authorized_official_first_name": "KANOKNUCH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-991-3544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "40303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.