Active NPI
Jesse Kendall Johnson, DDS
- Dentist
- Aliso Viejo, CA
National Provider Identifier
1306003355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 21146
- Practice address
- 24502 Pacific Park Dr
106
Aliso Viejo, CA 92656-3033 - Phone
- (949) 831-1946
- Fax
- (949) 643-2077
- NPI assigned
- May 19, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 21146 | CA | Primary |
Addresses
Primary practice location
24502 Pacific Park Dr
106
Aliso Viejo, CA 92656-3033
Mailing address
24502 Pacific Park Dr
106
Aliso Viejo, CA 92656-3033
Phone (949) 831-1946
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
| License | State | Type | Specialty |
|---|---|---|---|
| 21146 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1306003355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24502 PACIFIC PARK DR",
"address_2": "106",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926563033",
"telephone_number": "949-831-1946",
"fax_number": "949-643-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24502 PACIFIC PARK DR",
"address_2": "106",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926563033",
"telephone_number": "949-831-1946",
"fax_number": "949-643-2077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JESSE",
"middle_name": "KENDALL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "21146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aliso Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.