Kyle Bruce Van Brocklin, D.M.D., M.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

37177 Issued in CA

Practice address

525 Bollinger Canyon Way Ste 101
San Ramon, CA 94582-4935

Phone

(925) 735-8707

NPI assigned

Oct 21, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659454015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 BOLLINGER CANYON WAY STE 101",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824935",
            "telephone_number": "925-735-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BOLLINGER CANYON WAY STE 101",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824935",
            "telephone_number": "925-735-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN BROCKLIN",
        "first_name": "KYLE",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "37177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Valdivia
• Brianna L Valentine
• Emmanuel M Valino, DDS
• Karina Valle
• Valley Digestive Care
• Kristin Jane Van de Carr
• Harry Robert Van Den Berg, DDS
• Alison Van Hoff, 1-15-18398
• Sabrina Van Zuiden
• Samuel H Vance

• Oral and Maxillofacial Surgery (Dentist) in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.