Individual provider Active NPI

Shivanesh Naicker, DMD

  • Dentist
  • San Francisco, CA
National Provider Identifier
1003664426
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
110062 Issued in CA
Practice address
450 Sutter St RM 808
San Francisco, CA 94108-3910
Phone
(415) 513-5066
NPI assigned
May 9, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 110062 CA Primary

Addresses

Primary practice location

450 Sutter St RM 808
San Francisco, CA 94108-3910

Mailing address

657 Spruce Ave
South San Francisco, CA 94080-2751
Phone (650) 922-8418

Other practice location 1

290 King St Unit 8
San Francisco, CA 94107-6440
Phone (415) 618-0890

Other practice location 2

1133 El Camino Real Ste 5
South San Francisco, CA 94080-3288
Phone (650) 244-9928

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
110062CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Darren D Wong DDS Inc Dentist PastSince Nov 8, 2025 Accepting new patients
Pure Smile Dental Group Past Accepting new patients
Mina Levi, DDS, Inc PastSince Aug 18, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1003664426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 SPRUCE AVE",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940802751",
            "telephone_number": "650-922-8418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 SUTTER ST RM 808",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941083910",
            "telephone_number": "415-513-5066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 King St Unit 8",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941076440",
            "country_code": "US",
            "telephone_number": "415-618-0890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1133 El Camino Real Ste 5",
            "address_purpose": "LOCATION",
            "city": "South San Francisco",
            "state": "CA",
            "postal_code": "940803288",
            "country_code": "US",
            "telephone_number": "650-244-9928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAICKER",
        "first_name": "SHIVANESH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "110062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.