NPI Code Detail JSON Logo

1992209266 NPI number — KATELYN SMITH KONDRA MD

NPI Number: 1992209266
Health Care Provider/Practitioner: KATELYN SMITH KONDRA MD

Information about “1992209266” NPI (KATELYN SMITH KONDRA MD) exists in 1992209266 in HTML format HTML  |  1992209266 in plain Text format TXT  |  1992209266 in PDF (Portable Document Format) PDF  |  1992209266 in an XML format XML  formats.

NPI Number : 1992209266 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992209266",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KONDRA",
    "FirstName": "KATELYN",
    "MiddleName": "SMITH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16212 SHADOW MOUNTAIN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PACIFIC PALISADES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90272-2300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-804-4665",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1200 N STATE ST",
    "SecondLinePracticeLocationAddress": "CLINIC TOWER, SUITE A7D",
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90033-1029",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-804-4665",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/21/2018",
    "LastUpdateDate": "03/01/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "164587",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.