Active NPI
Lakshmi Keerthana Killampalli
- Dentist
- Tustin, CA
National Provider Identifier
1124835889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 107949
- Practice address
- 17400 Irvine Blvd Ste E
Tustin, CA 92780-3030 - Phone
- (657) 582-6111
- NPI assigned
- Dec 16, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 107949 | CA | Primary |
Addresses
Primary practice location
17400 Irvine Blvd Ste E
Tustin, CA 92780-3030
Mailing address
10946 Champions LN
Cypress, CA 90720-5264
Phone (657) 582-6111
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734307200000",
"number": "1124835889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10946 CHAMPIONS LN",
"city": "CYPRESS",
"state": "CA",
"postal_code": "907205264",
"telephone_number": "657-582-6111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17400 IRVINE BLVD STE E",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803030",
"telephone_number": "657-582-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLAMPALLI",
"first_name": "LAKSHMI",
"middle_name": "KEERTHANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-16",
"last_updated": "2024-12-16",
"certification_date": "2024-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "107949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.