NPIMap

Organization Active NPI

Jones, Kellen Kirsch Professional Corp.

  • General Practice Dentistry
  • Lake Forest, CA
National Provider Identifier
1811910987
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D21375 Issued in CA
Legal business name
JONES, KELLEN KIRSCH PROFESSIONAL CORP.
Practice address
24400 Muirlands Blvd
Suite D
Lake Forest, CA 92630-3946
Phone
(949) 586-0270
Fax
(949) 859-8446
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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

Authorized official

Name
Dr. Peter M Kellen, D.D.S.NPI 1609880871
Title
President
Phone
(949) 586-0270

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D21375 CA Primary

Addresses

Primary practice location

24400 Muirlands Blvd
Suite D
Lake Forest, CA 92630-3946

Mailing address

24400 Muirlands Blvd
Suite D
Lake Forest, CA 92630-3946
Phone (949) 586-0270

National Provider Directory

National Provider Directory

Locations

24400 Muirlands Blvd
Ste D
Lake Forest, CA 92630
Phone (949) 586-0270

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1811910987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24400 MUIRLANDS BLVD",
            "address_2": "SUITE D",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926303946",
            "telephone_number": "949-586-0270",
            "fax_number": "949-859-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24400 MUIRLANDS BLVD",
            "address_2": "SUITE D",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926303946",
            "telephone_number": "949-586-0270",
            "fax_number": "949-859-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONES, KELLEN KIRSCH PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "KELLEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-586-0270",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "D21375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.