Active NPI
Kenneth Leong, DDS
- Dentist
- Hesperia, CA
National Provider Identifier
1730560715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63655
- Practice address
- 12821 Main St
Suite 150
Hesperia, CA 92345-9126 - Phone
- (760) 981-0233
- NPI assigned
- Jun 15, 2015
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 63655 | CA | Primary |
Addresses
Primary practice location
12821 Main St
Suite 150
Hesperia, CA 92345-9126
Mailing address
22372 Kicking Horse Dr
Diamond Bar, CA 91765-3659
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 |
|---|---|---|---|---|
| I20180307002399 | CA | Order and Referring Only - Dentist | 3971864919 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434326400000",
"number": "1730560715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22372 KICKING HORSE DR",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917653659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12821 MAIN ST",
"address_2": "SUITE 150",
"city": "HESPERIA",
"state": "CA",
"postal_code": "923459126",
"telephone_number": "760-981-0233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEONG",
"first_name": "KENNETH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-15",
"last_updated": "2015-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hesperia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; 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.