Pono Kelly, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

63046 Issued in CA

Practice address

1125 E California Ave
Bakersfield, CA 93307-1201

Phone

(661) 632-2144

Fax

(661) 328-4211

NPI assigned

Apr 3, 2014

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1871911032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 WHITE ALDER DR",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933144281",
            "telephone_number": "661-304-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E CALIFORNIA AVE",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933071201",
            "telephone_number": "661-632-2144",
            "fax_number": "661-328-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "PONO",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willie Lee Kelley III
• Brandy Kelly
• Karen J Kelly, MS, CCC-SLP
• Larkin Kelly, BA
• Melissa Kelly, LCSW, PPSC
• Troy Vincent Kelly
• Javon Kemp Sr., MH COUNSELOR
• Yvonne Dorene Kendrick
• Amazine Rene Kendricks, DOULA
• Vicki Lynn Kenefsky

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; 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.