Active NPI
DRS Shturman and Kisilyuk Inc
- Dentist
- San Mateo, CA
National Provider Identifier
1093961807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 45646
- Legal business name
- DRS SHTURMAN AND KISILYUK INC
- Practice address
- 100 S Ellsworth Ave
Ste 809
San Mateo, CA 94401-3939 - Phone
- (650) 343-4477
- Fax
- (650) 343-4412
- NPI assigned
- Aug 12, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Russell Shturman
- Title
- Practice Manager
- Phone
- (650) 343-4477
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 45646 | CA | Primary |
Addresses
Primary practice location
100 S Ellsworth Ave
Ste 809
San Mateo, CA 94401-3939
Mailing address
100 S Ellsworth Ave
Ste 809
San Mateo, CA 94401-3939
Phone (650) 343-4477
Other names 1
- DENTAL MEDICINE PROVIDERS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930012435 | CA | DME Supplier - Oral Surgery - Dentist | 2062602576 | Practice locations: San Mateo, CA |
National Provider Directory
National Provider Directory- Tax ID family
- Dental Medicine Providers
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dentist
- San Rafael, CA
- NPI 1205129624
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Sacramento, CA
- NPI 1215108527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218499200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1490745600000",
"number": "1093961807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S ELLSWORTH AVE",
"address_2": "STE 809",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013939",
"telephone_number": "650-343-4477",
"fax_number": "650-343-4412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S ELLSWORTH AVE",
"address_2": "STE 809",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013939",
"telephone_number": "650-343-4477",
"fax_number": "650-343-4412"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRS SHTURMAN AND KISILYUK INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-12",
"last_updated": "2017-03-29",
"status": "A",
"authorized_official_last_name": "SHTURMAN",
"authorized_official_first_name": "RUSSELL",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "650-343-4477",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "CA",
"license": "45646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "DENTAL MEDICINE PROVIDERS",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.