| NPI |
1699807990 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
1 |
|
| Provider Last Name Legal Name |
KOLE |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Provider First Name |
JOHN |
The first name of the provider, if the provider
is an individual. |
| Provider Middle Name |
RAYMOND |
The middle name of the provider, if the provider
is an individual. |
| Provider Name Prefix Text |
DR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
| Provider Credential Text |
DC |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
| Provider First Line Business Practice Location Address |
1500 E KATELLA AVE |
The State code in the location of the provider
being identified. |
| Provider Second Line Business Practice Location Address |
G |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address City Name |
ORANGE |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
CA |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
928675008 |
The fax number associated with the location
address of the provider being identified. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
7142832288 |
The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date |
3/12/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
12/5/2023 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
111N00000X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider License Number 1 |
DC28572 |
|
| Provider License Number State Code 1 |
CA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
12/5/2023 |
|