Karlyle Ponce Jureidini, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

299639 Issued in CA

Practice address

241 Imperial Hwy Ste 330
Fullerton, CA 92835-1056

Phone

(714) 297-0712

Fax

(657) 217-2764

NPI assigned

Dec 10, 2020

Last updated

May 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Kyle Ponce Jureidini Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1417553785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 IMPERIAL HWY STE 330",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351056",
            "telephone_number": "714-297-0712",
            "fax_number": "805-527-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 IMPERIAL HWY STE 330",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351056",
            "telephone_number": "714-297-0712",
            "fax_number": "657-217-2764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1922 Erringer Rd",
            "address_purpose": "LOCATION",
            "city": "Simi Valley",
            "state": "CA",
            "postal_code": "930653525",
            "country_code": "US",
            "telephone_number": "805-584-0001",
            "fax_number": "805-527-9135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUREIDINI",
        "first_name": "KARLYLE",
        "middle_name": "PONCE",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-10",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "299639",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "299639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLE",
            "last_name": "JUREIDINI",
            "middle_name": "PONCE",
            "prefix": "MR.",
            "credential": "DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sihun Jung
• Yongsub Jung
• Ashley Jungkman, RD
• Juniper Terrace, Inc.
• Juniper Villa Inc. (Juniper Villa)
• Allison D Jurisch
• Paulo Narvaez Jusay, MSN, ACNP, APRN,BC
• K&Y Acupuncture
• Kairos Management (Acacia Villas)
• Kenneth Burton Kaisch, PH.D.

• Physical Therapist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; 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.