Individual provider Active NPI

Kelvin Chou, D.D.S

  • Endodontics
  • San Diego, CA
National Provider Identifier
1306156823
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
102140 Issued in CA
Practice address
6235 Lusk Blvd
San Diego, CA 92121-2731
Phone
(858) 558-3636
NPI assigned
Oct 18, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019028505 IL
Endodontics 1223E0200X 102140 CA Primary

Addresses

Primary practice location

6235 Lusk Blvd
San Diego, CA 92121-2731

Mailing address

6235 Lusk Blvd
San Diego, CA 92121-2731
Phone (858) 558-3636

Other practice location 1

4239 S. Archer Ave
Chicago, IL 60632
Phone (847) 461-9654

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

LicenseStateTypeSpecialty
102140CAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Jessica Roeber, DDS Endodontics CurrentSince Oct 6, 2024 Accepting new patients
Kelvin Chou DDS, Inc Endodontics CurrentSince Oct 6, 2024 Accepting new patients

Locations

6235 Lusk Blvd
San Diego, CA 92121
Phone (858) 558-3636

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1306156823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6235 LUSK BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212731",
            "telephone_number": "858-558-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6235 LUSK BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212731",
            "telephone_number": "858-558-3636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4239 S. Archer Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60632",
            "country_code": "US",
            "telephone_number": "847-461-9654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHOU",
        "first_name": "KELVIN",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-18",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028505",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "102140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.