Herawati Tirtadjaja Kandou, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9708 Issued in NJ

Practice address

35 Jefferson Avenue
Elizabeth, NJ 07201-2425

Phone

(908) 354-1188

Fax

(908) 352-7390

NPI assigned

Jun 26, 2009

Last updated

Jun 26, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Herawati T Kandou DDS PA

  • Dentist
  • Elizabeth, NJ
  • NPI 1871666586
  NPD (past) Authorized official

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245974400000",
    "number": "1023246105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 JEFFERSON AVENUE",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072012425",
            "telephone_number": "908-354-1188",
            "fax_number": "908-352-7390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 JEFFERSON AVENUE",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072012425",
            "telephone_number": "908-354-1188",
            "fax_number": "908-352-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDOU",
        "first_name": "HERAWATI",
        "middle_name": "TIRTADJAJA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-26",
        "last_updated": "2009-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "9708",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "3026",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3141209-01",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Kahn, D.M.D.
• Samuel Kahnowitz
• Leora Kaminer, M.A. CCC-SLP
• Thomas Kampo, PA-C
• Jina Kandas, DDS
• Joo Hee Kang, DMD
• Ashwin M Kansagra, M.D.
• Jennifer Kantor
• Samjhana Karki, RDN
• Michael Jay Katz, PT

• Dentist in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; 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.