Active NPI
Kevin Vankanegan, DDS
- Dentist
- Downers Grove, IL
National Provider Identifier
1124249008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019-023394
- Practice address
- 3450 Lacey Rd
Downers Grove, IL 60515-5430 - Phone
- (630) 515-7474
- Fax
- (630) 515-7290
- NPI assigned
- May 1, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019-023394 | IL | Primary |
Addresses
Primary practice location
3450 Lacey Rd
Downers Grove, IL 60515-5430
Mailing address
3450 Lacey Rd
Downers Grove, IL 60515-5430
Phone (630) 515-7474
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 22, 2015 through Sep 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-023394 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377734400000",
"number": "1124249008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 LACEY RD",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605155430",
"telephone_number": "630-515-7474",
"fax_number": "630-515-7290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 LACEY RD",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "605155430",
"telephone_number": "630-515-7474",
"fax_number": "630-515-7290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANKANEGAN",
"first_name": "KEVIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2013-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-023394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downers Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.