Active NPI
Kelie Kang
- Dentist
- Oakland, CA
National Provider Identifier
1679764765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 55786
- Practice address
- 1530 Broadway
Oakland, CA 94612-2002 - Phone
- (510) 251-1000
- Fax
- (510) 251-9264
- NPI assigned
- Aug 5, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 55786 | CA | Primary |
Addresses
Primary practice location
1530 Broadway
Oakland, CA 94612-2002
Mailing address
1333 Gough St
11F
San Francisco, CA 94109-6562
Phone (415) 441-1576
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D55786 | Medicaid | CA |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151001001070 | CA | Order and Referring Only - Dentist | 7315255932 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55786 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental Services, Inc. | Dentist | Past | Accepting new patients |
Interoperability endpoints
- kkang@direct.westerndental.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Oakland, CA
- NPI 1154485654
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187913600000",
"number": "1679764765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 GOUGH ST",
"address_2": "11F",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941096562",
"telephone_number": "415-441-1576",
"fax_number": "714-571-3560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1530 BROADWAY",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946122002",
"telephone_number": "510-251-1000",
"fax_number": "510-251-9264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANG",
"first_name": "KELIE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-05",
"last_updated": "2007-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "55786",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D55786",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.