Individual provider Active NPI

Kyalon Ray Graves

  • Independent Duty Corpsman
  • San Diego, CA
National Provider Identifier
1417218082
Registry record updated May 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Independent Duty CorpsmanTaxonomy code 1710I1002X
Practice address
34101 Farenholt Ave BLDG 14
San Diego, CA 92134-7000
Phone
(619) 532-6195
NPI assigned
May 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X Primary

Addresses

Primary practice location

34101 Farenholt Ave BLDG 14
San Diego, CA 92134-7000

Mailing address

6721 Mattney Cir
Dallas, TX 75237-2454
Phone (619) 537-8425

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

NPI Registry JSON

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1417218082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6721 MATTNEY CIR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752372454",
            "telephone_number": "619-537-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34101 FARENHOLT AVE BLDG 14",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921347000",
            "telephone_number": "619-532-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "KYALON",
        "middle_name": "RAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "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 May 31, 2012; 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.