Serkadis Amare Krohm

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

E1057222 Issued in CA

Practice address

1556 S Sultana Ave
Ontario, CA 91761-4238

Phone

(909) 418-6923

NPI assigned

Sep 16, 2013

Last updated

Sep 18, 2013By the provider in NPPES

Sex

Female

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1942636550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 CANYON CREST DR APT 14",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072985",
            "telephone_number": "951-288-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 S SULTANA AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917614238",
            "telephone_number": "909-418-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROHM",
        "first_name": "SERKADIS",
        "middle_name": "AMARE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-16",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "E1057222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Noelle Korhely-Day
• Sabrina Kornahrens
• Khushpreet Kour, DMD
• Imari Kowalski, LCSW
• Chelsi Kramp
• Sean Adrian Kruckenberg, LCSW
• Krupakar Yeturu DDS Inc (Ontario Chino Dental Center)
• KSL Dental Group Inc (Fresh Leaf Dental)
• Ktle DMD, PC
• Christopher Kubacki

• Student in an Organized Health Care Education/Training Program in Ontario, CA
• Providers in Ontario, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.