Individual provider Active NPI

Stephen K Kurumada, DDS

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1164547212
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
119105 Issued in CA
Practice address
1245 Wilshire Blvd
Suite 903
Los Angeles, CA 90017-4809
Phone
(213) 481-1420
Fax
(213) 481-0147
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 119105 CA Primary

Addresses

Primary practice location

1245 Wilshire Blvd
Suite 903
Los Angeles, CA 90017-4809

Mailing address

1245 Wilshire Blvd
Suite 903
Los Angeles, CA 90017-4809
Phone (213) 481-1420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160302002524 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6002112943

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19105CAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164547212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "SUITE 903",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174809",
            "telephone_number": "213-481-1420",
            "fax_number": "213-481-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "SUITE 903",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174809",
            "telephone_number": "213-481-1420",
            "fax_number": "213-481-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURUMADA",
        "first_name": "STEPHEN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "119105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.