Active NPI
Kenneth John Blunt, M.D.
- Specialist
- La Jolla, CA
National Provider Identifier
1689934168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G21211
- Practice address
- 5942 Avenida Chamnez
La Jolla, CA 92037-7402 - Phone
- (858) 459-5977
- Fax
- (858) 459-5977
- NPI assigned
- May 18, 2012
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G21211 | CA | Primary |
Addresses
Primary practice location
5942 Avenida Chamnez
La Jolla, CA 92037-7402
Mailing address
5942 Avenida Chamnez
Lajolla, CA 92037-7402
Phone (858) 459-5977
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G21211 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337299200000",
"number": "1689934168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5942 AVENIDA CHAMNEZ",
"city": "LAJOLLA",
"state": "CA",
"postal_code": "920377402",
"telephone_number": "858-459-5977",
"fax_number": "858-459-5977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5942 AVENIDA CHAMNEZ",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920377402",
"telephone_number": "858-459-5977",
"fax_number": "858-459-5977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUNT",
"first_name": "KENNETH",
"middle_name": "JOHN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-18",
"last_updated": "2012-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G21211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.