Kanika Yadav Ryan

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

021.003283 Issued in IL

Practice address

22 Glen Ed Professional Park Ste B
Glen Carbon, IL 62034-3300

Phone

(618) 659-2030

NPI assigned

Sep 28, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Endodontics of Edwardsville PLLC

  • Endodontics
  • Glen Carbon, IL
  • NPI 1487375549
  NPD

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1043934433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 GLEN ED PROFESSIONAL PARK STE B",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343300",
            "telephone_number": "618-659-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 GLEN ED PROFESSIONAL PARK STE B",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343300",
            "telephone_number": "618-659-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KANIKA",
        "middle_name": "YADAV",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-28",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019033258",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021.003283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce E Rotter, D.M.D.
• Samantha Rowe
• Zabree Marie Russell
• Leah Rutenberg, LCPC
• Ryan S. Diederich, MD PC
• Sam'S West Inc
• Sams West Inc
• Abiodun Sangoseni, MD
• Gabriel Asare Sarpong, MS, LCPC, CCM
• Tracy Lynn Sashidharan, L.C.P.C.

• All providers in Glen Carbon, IL
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.