Jessica Bong, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

59618 Issued in CA

Practice address

19366 Soledad Canyon Rd
Canyon Country, CA 91351-2629

Phone

(661) 252-8888

NPI assigned

Sep 28, 2010

Last updated

Sep 28, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Alexi Kossi, DDS Inc.

  dba Smile City Dental Group

  • General Practice Dentistry
  • Canyon Country, CA
  • NPI 1811003049
  NPD (past)

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1578872313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N 1ST ST UNIT 332",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19366 SOLEDAD CANYON RD",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913512629",
            "telephone_number": "661-252-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONG",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-28",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "59618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beyond the Box Therapy
• Robert Bitner, RCP, CRTT
• Mary Bizzle, RD.
• Krystal Janae Blunt, LVN
• Shawn Michael Bond, P.A.-C
• Bracamontes Chiropractic Corp.
• Raymond Bracamontes, DC
• Breast Time of Life LLC
• Brenda Paola Briviesca
• Elliot Mark Bronwein, OD.

• Dentist in Canyon Country, CA
• Providers in Canyon Country, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.