KELLY DE GONZALES (NPI# 1184899874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184899874 |
| Entity Type | Individual |
| Full Name | KELLY DE GONZALES |
| Credential | M.D. |
| Practice Address |
150 N Jackson Ave Suite 100 San Jose CA 95116-1908 |
| Practice Telephone | 4087702297 |
| Practice Fax Number | 4087702649 |
| Mailing Telephone | 4087702297 |
| Mailing Fax Number | 4087702649 |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2015-10-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 258365 | MA | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | AH19180185639 | MA | Allopathic & Osteopathic Physicians |
| Y | 208600000X | Surgery | A109752 | CA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194109702 | Kelly D Gonzales | Nurse Practitioner | 4282 Genesee Ave Ste 103, San Diego, CA 92117 | 2015-07-13 |
| 1770192841 | Kelly Gonzales | Behavior Technician | 8885 Rio San Diego Dr Ste 340, San Diego, CA 92108-1669 | 2020-07-24 |
| 1669887584 | Kelly Gonzales | Nurse Practitioner | 985330 Nebraska Medical Ctr, Omaha, NE 68198-5330 | 2014-06-30 |
| 1497088868 | Kelly Herzstein Gonzales | Counselor | 7225 N 1st St, Suite 101, Fresno, CA 93720-2986 | 2009-09-16 |
| 1417128687 | Kelly Marie Gonzales | Dentist | 1103 Rivery Blvd, Ste. 140, Georgetown, TX 78628-3034 | 2008-03-17 |
| 1720188295 | Kelly Aileen Gonzales | Physician Assistant | 5207 Heritage Ave, Colleyville, TX 76034 | 2006-09-25 |
| Street Address |
150 N JACKSON AVE SUITE 100 |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95116-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417931114 | Ralph Stephen Zotovich | Dentist | 150 N Jackson Ave, Suite 110, San Jose, CA 95116-1908 | 2005-12-06 |
| 1760969539 | Spread Your Wings for Mental Health Inc. | Clinic/Center | 150 N Jackson Ave, San Jose, CA 95116-1908 | 2018-07-25 |
| 1679006209 | Reozel Realon Buquing, Dds, Inc. | Dentist | 150 N Jackson Ave, Suite 108, San Jose, CA 95116-1908 | 2017-04-11 |
| 1649673526 | San Jose Surgical Group | Surgery | 150 N Jackson Ave, Suite 100, San Jose, CA 95116-1908 | 2014-10-06 |
| 1316351216 | Don Allen Stevenson Dds Inc. | Dentist | 150 N Jackson Ave, Suite 204, San Jose, CA 95116-1908 | 2014-06-18 |
| 1629386198 | South Bay Gi Inc | Internal Medicine | 150 N Jackson Ave, Suite 107, San Jose, CA 95116-1908 | 2010-09-18 |
| 1427299098 | Dennis Terrak Calvert | Dentist | 150 N Jackson Ave, Suite 210, San Jose, CA 95116-1908 | 2009-03-11 |
| 1912105917 | Gregory Rex Burnett | Dentist | 150 N Jackson Ave, #211, San Jose, CA 95116-1908 | 2007-07-11 |
| 1093928939 | Floro Bayle Ramirez | Dentist | 150 N Jackson Ave, Suite 108, San Jose, CA 95116-1908 | 2007-05-08 |
| 1427277342 | Michael Oran Bambico | Dentist | 150 N Jackson Ave, Suite # 103, San Jose, CA 95116-1908 | 2007-04-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821570102 | Lori Chung Cho Dmd Inc. | Clinic/Center | 150 N Jackson Ave Ste 103, San Jose, CA 95116 | 2018-09-03 |
| 1306333174 | Patrick Suezaki | Dentist | 250 Montclair Ave Ste C, San Jose, CA 95116 | 2018-04-17 |
| 1871016147 | Israel Enrique Ruiz Lora | Social Worker | 1075 East Santa Clara, San Jose, CA 95116 | 2017-07-19 |
| 1275072613 | Araceli Yazmin Garcia | Case Manager/Care Coordinator | 1652 E San Fernando St, San Jose, CA 95116 | 2017-02-17 |
| 1710304712 | Natalie K. Huynh D.d.s Inc. | Dentist | 2340 Mckee Rd #24, San Jose, CA 95116 | 2014-03-27 |
| 1437597747 | Ian Ellis Mccoy | Internal Medicine | 2360 Mckee Rd Ste 10, San Jose, CA 95116 | 2013-06-08 |
| 1588913321 | Adrian Fernandez | Counselor | 1245 East Santa Clara Street, San Jose, CA 95116 | 2012-09-07 |
| 1851678841 | Krystal Lani Subia | Counselor | 101 Jose Figueres Avenue, San Jose, CA 95116 | 2011-11-04 |
| 1255668224 | Sophia O.j.m. Dijkstra | Physical Therapist | 180 N. Jackson Ave, San Jose, CA 95116 | 2009-11-11 |
| 1255562096 | Jovan De Guzman Sedilla | Physical Therapy Assistant | 180 N. Jackson Ave., San Jose, CA 95116 | 2009-07-28 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215407218 | Vascular and Endovascular Surgery, PC | Surgery | 2505 Samaritan Dr Ste 503, San Jose, CA 95124-4015 | 2018-12-03 |
| 1689095077 | Magnus Eric Kolbeinsson | Surgery | 4857 Rahway Dr, San Jose, CA 95111-3843 | 2014-01-02 |
| 1427493691 | Nhan Huynh | Surgery | 4757 Poston Dr, San Jose, CA 95136-3312 | 2013-05-01 |
| 1982953766 | Jin Y. Lee. Md. Inc. | Surgery | 100 O'connor Dr. #12, San Jose, CA 95128 | 2012-09-07 |
| 1659672160 | Amy Gonsier, M.d., Inc. | Surgery | 2025 Forest Ave Ste 8, San Jose, CA 95128-4806 | 2010-11-15 |
| 1629392022 | Harrison James Kornfield | Surgery | 455 Navaro Way, #108, San Jose, CA 95134 | 2010-03-15 |
| 1871701292 | Rodrigo Rivera Leon | Surgery | 810 Saratoga Ave, N-104, San Jose, CA 95129-2572 | 2007-05-18 |
| 1881749661 | Samaritan Surgical Clinic Inc | Surgery | 2505 Samaritan Dr #301, San Jose, CA 95124 | 2007-01-24 |
| 1043370505 | Victor Wh Tsang | Surgery | 2395 Montpelier Drive, Suite 5, San Jose, CA 95116 | 2006-12-12 |
| 1902979370 | Richard Schnabel | Surgery | 2505 Samaritan Dr Ste 504, San Jose, CA 95124-4014 | 2006-11-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.