KYLE ROBERT GREGORIO DAJAC DO
NPI 1558948190
Student in an Organized Health Care Education/Training Program in Orange Park, FL

Q: What is Kyle Robert Dajac's NPI number?

The NPI number for Kyle Robert Dajac is 1558948190. It was assigned to this individual provider in the NPPES registry on March 29, 2021.

Q: What is Kyle Robert Dajac's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kyle Robert Dajac was last updated on March 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 29, 2021PECOS Enrolled

2001 KINGSLEY AVE, ORANGE PARK, FL 32073(904) 639-2000 Get Directions Write a Review

NPPES record last updated: March 29, 2021. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Kyle Robert Gregorio Dajac Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYLE ROBERT GREGORIO DAJAC DO (NPI 1558948190) is an individual student in an organized health care education/training program in Orange Park, Florida and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1558948190

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameKYLE ROBERT GREGORIO DAJACCredential: DO

Location Address2001 KINGSLEY AVEOrange Park, FL 32073-5148

Mailing Address2001 Kingsley AveOrange Park, FL 32073-5148 · Fax (904) 639-2015

Phone(904) 639-2000

Sole ProprietorYes

Medical School CMSOtherGraduated 2021

Enumeration DateMarch 29, 2021

NPPES CertifiedMarch 24, 2021

✔ NPI 1558948190 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2001 KINGSLEY AVE, Orange Park, FL 32073

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kyle Robert Gregorio Dajac Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4183180284

PECOS Enrollment IDI20260729002321

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FORREST KING M.D.

Emergency Medicine