Active NPI
Kevin Ju, DDS
- General Practice Dentistry
- Palmdale, CA
National Provider Identifier
1700952801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 54002
- Practice address
- 39345 10TH St W
Building B
Palmdale, CA 93551-3779 - Phone
- (661) 274-8065
- NPI assigned
- Nov 28, 2006
- Last updated
- Apr 17, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 54002 | CA | Primary |
Addresses
Primary practice location
39345 10TH St W
Building B
Palmdale, CA 93551-3779
Mailing address
44439 17TH St W Ste 201
Lancaster, CA 93534-2856
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 |
|---|---|---|---|---|
| I20160113001635 | CA | Order and Referring Only - Dentist | 3870895402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54002 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523923200000",
"number": "1700952801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44439 17TH ST W STE 201",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935342856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39345 10TH ST W",
"address_2": "BUILDING B",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935513779",
"telephone_number": "661-274-8065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JU",
"first_name": "KEVIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2018-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "54002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.