Konita Lee Wilks, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

63433 Issued in CA

Practice address

10602 Chapman Ave
Garden Grove, CA 92840-3146

Phone

(714) 537-0700

NPI assigned

Jun 12, 2014

Last updated

Nov 8, 2015By 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

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• County of Los Angeles

  dba Los Angeles County Olive View-UCLA Medical Center

  • Psychiatric Hospital Unit
  • Sylmar, CA
  • NPI 1669496097

  Corporate Director, W-2 Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Los Angeles

  • Psychiatric Hospital Unit
  • Torrance, CA
  • NPI 1326061078
  NPD (past)

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446940800000",
    "number": "1992119598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 KENWICK CIR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481036",
            "telephone_number": "714-642-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10602 CHAPMAN AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928403146",
            "telephone_number": "714-537-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKS",
        "first_name": "KONITA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2015-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "63433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Satria Wiguna, DO
• Zoe Wilcoxson
• Shawn Elizabeth Wild
• Mikhayla Desiree Wilkins
• Camille Ashley Wilkinson
• William Park, M.D., Inc
• Jasmine Williams McCane, BT
• Sandi Williams-Dill
• Asia Williams
• Camri Williams

• Pediatric Dentistry in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.