Shanmukha Reddy Kallam, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS042550 Issued in PA

Practice address

1575 N 52ND St Ste 705
Philadelphia, PA 19131-4729

Phone

(215) 879-1777

NPI assigned

Feb 12, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Dental, LLC

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1255619920
  NPD (past)

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1184257610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 SHORT HILLS BLVD",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085274883",
            "telephone_number": "732-678-7185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 N 52ND ST STE 705",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191314729",
            "telephone_number": "215-879-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAM",
        "first_name": "SHANMUKHA REDDY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS042550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marin Kalista, MS, LCGC
• Jocelyn Kalkbrenner
• David Kalkstein, MD, PHD
• Aditi Kalla, M.D.
• Amandeep Kaur Kallah, DMD
• Stacey Michelle Kallem, MD
• Caleb B. Kallen, M.D.
• Christopher Martin Kallighan, DPT
• Charikleia Kalliora, MD, MSC
• Christos Kallis, MB.BS

• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; 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.