Individual provider Active NPI

Kinjal Patel

  • Dentist
  • Austin, TX
National Provider Identifier
1104403484
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
38399 Issued in TX
Practice address
12901 N Interstate 35
Austin, TX 78753-1019
Phone
(737) 717-0244
NPI assigned
Mar 24, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 38399 TX Primary

Addresses

Primary practice location

12901 N Interstate 35
Austin, TX 78753-1019

Mailing address

12901 N Interstate 35
Austin, TX 78753-1019
Phone (737) 717-0244

Other practice location 1

440 E Tampa St
Springfield, MO 65806-1131
Phone (417) 831-0150

Other practice location 2

20302 US Highway 59 Ste B
New Caney, TX 77357-8638
Phone (281) 306-2832

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

LicenseStateTypeSpecialty
38399TXMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1104403484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12901 N INTERSTATE 35",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787531019",
            "telephone_number": "737-717-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 N INTERSTATE 35",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787531019",
            "telephone_number": "737-717-0244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 E Tampa St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658061131",
            "country_code": "US",
            "telephone_number": "417-831-0150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20302 US Highway 59 Ste B",
            "address_purpose": "LOCATION",
            "city": "New Caney",
            "state": "TX",
            "postal_code": "773578638",
            "country_code": "US",
            "telephone_number": "281-306-2832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KINJAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "38399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.