KDPK IV, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KDPK IV, INC.

Practice address

3810 Governor Dr
San Diego, CA 92122-2441

Phone

(858) 583-6431

Fax

(858) 587-2802

NPI assigned

Nov 4, 2022

Organization subpart

No

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

Authorized official

Name

Flora KellyNPI 1134535719

Title

Ceo

Phone

(858) 583-6431

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Flora Kelly

  • Assisted Living Facility
  • San Diego, CA
  • NPI 1134535719
  NPD Authorized official

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

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1740997097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6311 DENNISON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921222401",
            "telephone_number": "858-583-6431",
            "fax_number": "858-587-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 GOVERNOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921222441",
            "telephone_number": "858-583-6431",
            "fax_number": "858-587-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KDPK IV, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-583-6431"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in San Diego, CA
• Providers in San Diego, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.