Active NPI
Kenneth G. Koch, DC
- Chiropractor
- San Diego, CA
National Provider Identifier
1649466053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC14114
- Practice address
- 9484 Black Mountain Rd
Ste I
San Diego, CA 92126-4520 - Phone
- (858) 484-8548
- NPI assigned
- Sep 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC14114 | CA | Primary |
Addresses
Primary practice location
9484 Black Mountain Rd
Ste I
San Diego, CA 92126-4520
Mailing address
9484 Black Mountain Rd Ste I
San Diego, CA 92126-4520
Phone (858) 484-8548
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC14114 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1649466053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9484 BLACK MOUNTAIN RD STE I",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264520",
"telephone_number": "858-484-8548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9484 BLACK MOUNTAIN RD",
"address_2": "STE I",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264520",
"telephone_number": "858-484-8548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCH",
"first_name": "KENNETH",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC14114",
"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 Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.