Kenneth J Brust

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

43905 Issued in CA

Practice address

16990 Main St
Suite 1
Hesperia, CA 92345-7919

Phone

(760) 244-7232

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 8, 2016 through Nov 8, 2026

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 and National Provider Directory roles.

• Hesperia Dental Center Inc.

  • General Practice Dentistry
  • Hesperia, CA
  • NPI 1417407677
  NPD (past) Authorized official
• Caballero Dental Corporation

  • Pediatric Dentistry
  • Hesperia, CA
  • NPI 1992624407
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821207507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16990 MAIN ST",
            "address_2": "SUITE 1",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923457919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16990 MAIN ST",
            "address_2": "SUITE 1",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923457919",
            "telephone_number": "760-244-7232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUST",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy I Brown
• Deven Brown
• Kathyrn Chelekis Brown, RPH
• Tasha Latrece Brown, ASW128458
• Tylea Brown
• Bryan a. Gunnoe, MD, Inc.
• Pamela Bryant
• Marcella Buckner, HEALTH CARE ADMINIST
• Julie Buenrostro
• Anne Thu Bui, OD

• General Practice Dentistry in Hesperia, CA
• Providers in Hesperia, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.