DR. KYLE BRUCE VAN BROCKLIN (NPI# 1659454015) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659454015 |
| Entity Type | Individual |
| Full Name | DR. KYLE BRUCE VAN BROCKLIN |
| Credential | D.M.D., M.S. |
| Practice Address |
525 Bollinger Canyon Way Ste 101 San Ramon CA 94582-4935 |
| Practice Telephone | 9257358707 |
| Mailing Telephone | 9257358707 |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
37177 | CA | Dental Providers |
| Street Address |
525 BOLLINGER CANYON WAY STE 101 |
| City | SAN RAMON |
| State | CA |
| Zip Code | 94582-4935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184252710 | John Paul Yap | Student in an Organized Health Care Education/Training Program | 741 Roseum Ct, San Ramon, CA 94582 | 2020-03-30 |
| 1740762103 | Gilan Mansour | Pharmacist | 7108 Watsonia Dr, San Ramon, CA 94582 | 2018-09-03 |
| 1235635624 | Justin Michael Chan | Pharmacist | 11440 Windemere Parkway, San Ramon, CA 94582 | 2018-04-04 |
| 1033643317 | Ebony Shaunte Berry | Behavior Technician | 3201 Crestfield Dr, San Ramon, CA 94582 | 2017-04-13 |
| 1558729202 | Hoa Trang | Pharmacist | 2053 Poinsettia Street, San Ramon, CA 94582 | 2016-02-09 |
| 1922364652 | Aruna Somani | Internal Medicine | 6400 Main Branch Road, San Ramon, CA 94582 | 2012-04-06 |
| 1790061364 | Darren Dong-shung Gae | Pharmacist | 11440 Windemere Pkwy, San Ramon, CA 94582 | 2011-10-27 |
| 1134457112 | Azmeena Amir Hashem | Nurse Practitioner | 3085 Lakemont Dr Unit 3, San Ramon, CA 94582 | 2009-12-02 |
| 1619985892 | Rashpal S. Deol | Dentist | 500 Bollinger Canyon Way Ste 8.5, San Ramon, CA 94582 | 2006-08-04 |
| 1851811822 | Revelcare LLC | Technician, Pathology | 11040 Bollinger Canyon Rd, Ste 839, San Ramon, CA 94582 | 2017-06-21 |
| Find all providers in zip 94582 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568972313 | Francis Chung Dds Inc II | Dentist | 111 Deerwood Rd Ste 372, San Ramon, CA 94583-4409 | 2017-10-06 |
| 1871617027 | Chan M Park | Dentist | 111 Deerwood Rd Ste 130, San Ramon, CA 94583-2194 | 2007-03-16 |
| 1588668206 | Anthony Joseph Rega | Dentist | 5401 Norris Canyon Rd, Ste 210, San Ramon, CA 94583-5408 | 2005-06-09 |
| 1124660014 | Chan M. Park, D.d.s., M.d., PC and Benjamin R. Shimel, D.d.s., PC A Pa | Dentist | 111 Deerwood Rd Ste 130, San Ramon, CA 94583-2194 | 2019-10-11 |
| 1023495637 | Benjamin Ryan Shimel | Dentist | 111 Deerwood Rd Ste 130, San Ramon, CA 94583-2194 | 2015-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807979 | Ayed Hawatmeh Dds Inc | Dentist | 322 E Foothill Blvd, Pomona, CA 91767 | 2020-10-02 |
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1609493170 | Amir Haghshenas Dds | Dentist | 3880 S Bascom Ave Ste 213, San Jose, CA 95124-2675 | 2020-07-01 |
| 1316568900 | Beech & Reid Dental Partnership | Dentist | 464 E Calaveras Blvd Ste B3, Milpitas, CA 95035-5412 | 2020-05-05 |
| 1518506773 | Francisco Suarez, Dds Inc. | Dentist | 4606 Hollywood Blvd Ste A, Los Angeles, CA 90027-5462 | 2020-01-04 |
| 1831748839 | Slate Dental Corporation | Dentist | 6512 Lonetree Blvd Ste 100, Rocklin, CA 95765-5883 | 2019-09-11 |
| 1255980140 | Dr Maloux Macasaet Saguin Dental Corporation | Dentist | 9800 Topanga Canyon Blvd Ste J, Chatsworth, CA 91311-4075 | 2019-09-04 |
| 1891342267 | Amrollahie and Riman Dental Partnership | Dentist | 1442 Irvine Blvd Ste 225, Tustin, CA 92780-3846 | 2019-08-21 |
| 1548821572 | Hoang Dental Corporation | Dentist | 1356 W Valley Pkwy Ste J, Escondido, CA 92029-2138 | 2019-06-20 |
| 1073173860 | Omfs Care Center Partners | Dentist | 215 N Fresno St Ste 490, Fresno, CA 93701-0000 | 2019-06-14 |
| Find all providers with the same taxonomy | ||||
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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.