Edward Agyekum
Individual provider Active NPI Dentist · Martinez, CA
NPI 1124196696 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124196696
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 38790 (CA)
- Practice address
- 2500 Alhambra Ave
Martinez, CA 94553-3156 - Phone
- (925) 370-5110
- Fax
- (925) 370-5142
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170802003704 | CA | Practitioner - Oral Surgery | 7911278387 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38790 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alameda Health System | Current | Accepting new patients | |
| Alameda Health System | Current |
Accepting new patients | |
| Alameda Health System | Current |
Accepting new patients |
Locations
15400 Foothill Blvd
Castro Valley, CA 94578
Phone (510) 346-1468
6955 Foothill Blvd
Ste 200
Oakland, CA 94605
Phone (510) 567-5700
1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323
Interoperability endpoints
- eagyekum9622@alamedahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 38790 | CA | Yes |
Addresses
Primary practice location
2500 Alhambra Ave
Martinez, CA 94553-3156
Mailing address
50 Douglas Dr
Suite 391
Martinez, CA 94553-4098
Phone (925) 957-5429
Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.