NPIMap

Organization Active NPI

Gwendolyn Kelly DDS & Assoc.

Doing business as Gwendolyn Kelly DDS

  • Dentist
  • Los Angeles, CA
National Provider Identifier
1558772723
Registry record updated May 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
29936 Issued in CA
Legal business name
GWENDOLYN KELLY DDS & ASSOC.
Doing business as
Gwendolyn Kelly DDS
Practice address
6230 W Manchester Ave
Los Angeles, CA 90045-3801
Phone
(310) 412-9291
NPI assigned
May 9, 2014
Last updated
May 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2014

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

Authorized official

Name
Dr. Gwendolyn A Kelly, DDSNPI 1316039324
Title
Owner
Phone
(310) 412-9291

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 29936 CA Primary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 45472 CA
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 20070 CA

Addresses

Primary practice location

6230 W Manchester Ave
Los Angeles, CA 90045-3801

Mailing address

6230 W Manchester Ave
Los Angeles, CA 90045-3801

Other names 1

  • GWENDOLYN KELLY DDS Doing business as

National Provider Directory

National Provider Directory

Locations

6230 W Manchester Ave
Westchester, CA 90045
Phone (310) 412-9291

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399593600000",
    "number": "1558772723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6230 W MANCHESTER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6230 W MANCHESTER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453801",
            "telephone_number": "310-412-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWENDOLYN KELLY DDS & ASSOC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-09",
        "last_updated": "2014-05-09",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-412-9291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "29936",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "45472",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "20070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GWENDOLYN KELLY DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; 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.