Kelgynn Sia Serbas, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DDS109764 Issued in CA

Practice address

27949 Greenspot Rd
Ste H
Highland, CA 92346

Phone

(909) 864-6010

NPI assigned

Aug 11, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jefferson and Chokka Professional Dental Corporation

  dba Highland Dental Group

  • General Practice Dentistry
  • Highland, CA
  • NPI 1366688525
  NPD (past)
• C S Dental

  dba Downtown Dental Center

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1326215237
  NPD (past)

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1720716350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12460 CALIFORNIA ST",
            "address_2": "#1409",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "92399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27949 GREENSPOT RD",
            "address_2": "STE H",
            "city": "HIGHLAND",
            "state": "CA",
            "postal_code": "92346",
            "telephone_number": "909-864-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERBAS",
        "first_name": "KELGYNN",
        "middle_name": "SIA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-11",
        "last_updated": "2024-05-24",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS109764",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122699",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhiannon Scray
• Ivonna Mae Seaton, NP
• Raymond Sedgh, M.D.
• Camille Segura, OTR/L
• Sequoia Palliative Care, LLC
• Serene Minds Counseling Services
• Edward Refugio Serros, MD
• Seunghwan Chung D.D.S., Inc.
• Dhaval Shah, DDS MDS
• Viral Shah, B.PHARM

• Dentist in Highland, CA
• Providers in Highland, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; 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.