Stephen S Kallaos, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

44903 Issued in CA

Practice address

24099 Postal Ave
Suite 102
Moreno Valley, CA 92553-7709

Phone

(951) 601-1385

Fax

(951) 601-1292

NPI assigned

Nov 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649349879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 OROVILLE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926020923",
            "telephone_number": "714-317-9821",
            "fax_number": "951-601-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24099 POSTAL AVE",
            "address_2": "SUITE 102",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537709",
            "telephone_number": "951-601-1385",
            "fax_number": "951-601-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAOS",
        "first_name": "STEPHEN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "44903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaiser Foundation Hospitals
• Kaiser Foundation Hospitals (Outpatient Services - Peritoneal Dialysis at Kaiser Moreno Valley CAPD)
• Kaiser Foundation Hospitals (Kaiser Foundation Hospital - Moreno Valley Psych Unit)
• Kaiser Permanente
• Kaitlyn Phuc Thuan Nguyen, DDS, Inc (Family Dental Center)
• Jason Michael Kamath, DO
• Ilho Kang, M.D.
• Dhaval Mahesh Kapadia, M.D.
• Annie Karanja
• Alexis Danielle Karim

• Periodontics in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.