Provider Demographics
NPI:1831060466
Name:KIDZMD DPC
Entity type:Organization
Organization Name:KIDZMD DPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER - PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-868-3045
Mailing Address - Street 1:556 RUSH CREEK PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9605
Mailing Address - Country:US
Mailing Address - Phone:816-264-7576
Mailing Address - Fax:816-264-7578
Practice Address - Street 1:556 RUSH CREEK PKWY STE B
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9605
Practice Address - Country:US
Practice Address - Phone:816-264-7576
Practice Address - Fax:816-264-7578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCIERGE CARE PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty