Active NPI
Gaurav Aidasani
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1083394704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.034550
- Practice address
- 4721 S Kedzie Ave
Chicago, IL 60632-3001 - Phone
- (773) 847-4444
- NPI assigned
- Jul 18, 2023
- Last updated
- Aug 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.034550 | IL | Primary |
Addresses
Primary practice location
4721 S Kedzie Ave
Chicago, IL 60632-3001
Mailing address
2 E Erie St Apt 3512
Chicago, IL 60611-3161
Phone (310) 351-2918
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
| License | State | Type | Specialty |
|---|---|---|---|
| 019.034550 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kedzie 47 Dental LLC | General Practice | Current | Accepting new patients |
Locations
4721 S Kedzie Ave
Chicago, IL 60632
Phone (773) 847-4444
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1083394704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 E ERIE ST APT 3512",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113161",
"telephone_number": "310-351-2918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4721 S KEDZIE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606323001",
"telephone_number": "773-847-4444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AIDASANI",
"first_name": "GAURAV",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-18",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.034550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.