Healthcare Provider Details

I. General information

NPI: 1912250176
Provider Name (Legal Business Name): KJELD AAMODT DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MARKET ST STE 1200
SAN FRANCISCO CA
94105-3214
US

IV. Provider business mailing address

605 MARKET ST STE 1200
SAN FRANCISCO CA
94105-3214
US

V. Phone/Fax

Practice location:
  • Phone: 831-238-7285
  • Fax:
Mailing address:
  • Phone: 831-238-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number64545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: