Individual provider Active NPI

Sandeep Kumar, DDS

  • Dentist
  • Vallejo, CA
National Provider Identifier
1043076383
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
109899 Issued in CA
Practice address
3400 Sonoma Blvd
Vallejo, CA 94590-2972
Phone
(707) 554-4000
NPI assigned
Feb 26, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 109899 CA Primary

Addresses

Primary practice location

3400 Sonoma Blvd
Vallejo, CA 94590-2972

Mailing address

251 Windsor Way
Vallejo, CA 94591-6870
Phone (929) 369-0999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930003079 CA Order and Referring Only - DentistPractitioner - Dentist 0345771424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
109899CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cherag Dinshaw Sarkari DDS a Dental Corporation PastSince Mar 3, 2024 Accepting new patients
Western Dental Services, Inc. Dentist PastSince Mar 3, 2024 Accepting new patients

Organizations & group practices 2

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": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1043076383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 WINDSOR WAY",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945916870",
            "telephone_number": "929-369-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SONOMA BLVD",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902972",
            "telephone_number": "707-554-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "SANDEEP",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "109899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.