Kenneth Edward Siebert Jr.
Military Health Care Provider (Independent Duty Corpsman)

Address: 4831 Shields St, San Diego, CA 92124-2930
Phone: 6193329330

Kenneth Edward Siebert Jr. (NPI# 1275152654) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1275152654
Entity Type Individual
Full Name Kenneth Edward Siebert Jr.
Credential IDC
Gender Male
Practice Address 4831 Shields St
San Diego
CA 92124-2930
Practice Telephone 6193329330
Mailing Address 4831 Shields St
San Diego
CA 92124-2930
Mailing Telephone 6193329330
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2020-04-15
Last Update Date 2020-04-15

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 1710I1002X Military Health Care Provider · Independent Duty Corpsman Other Service Providers

Taxonomy Information

Taxonomy Code 1710I1002X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Corpsman

Taxonomy Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]

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Office Location

Street Address 4831 SHIELDS ST
State CA
Zip Code 92124-2930

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1780150334 Paullette Michelle Rosette Marriage & Family Therapist 5421 Escarchosa Lane, San Diego, CA 92124 2018-10-22
1699253179 Laura Lychelle Kime Behavior Analyst 4256 Tambor Ct, San Diego, CA 92124 2018-08-06
1720506850 Jonathan Jacobs Military Health Care Provider 3064 Taussig St, San Diego, CA 92124 2017-09-08
1568856235 Alvin Nguyen Student in an Organized Health Care Education/Training Program 10872 Portobelo Dr., San Diego, CA 92124 2015-03-20
1346552064 Jeffrey Thomas Gilbert Military Health Care Provider 3841 Colina Dorado Dr, Apartment G108, San Diego, CA 92124 2010-07-10
1023334158 Billy L Fuson Jr. Military Health Care Provider 6656 Antigua Blvd, San Diego, CA 92124 2010-04-14
1386866473 Ephraim J. Tabornal, Dds, Inc. Dentist 10850 Baroque Lane, Suite C, San Diego, CA 92124 2007-05-02
1538255245 Lisa Anne Hazlewood-hunt Psychologist 11770 Bernardo Plaza Ct. Suite 260, San Diego, CA 92124 2006-10-04
1740393586 Brian L Mcdonald Physical Therapist 5950 Santo Road, Suite D, San Diego, CA 92124 2006-08-16
1003820614 Eileen Louise Holman Social Worker 6586 Ambrosia Drive, #5204, San Diego, CA 92124 2006-07-28
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Zip Code 92124

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Dataset Information

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.

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