Individual provider Active NPI

Kevin Michael Bunin, DDS

  • Dentist
  • Sterling, VA
National Provider Identifier
1205064987
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401413641 Issued in VA
Practice address
14 Pidgeon Hill Dr Ste 200
Sterling, VA 20165-6133
Phone
(703) 444-4104
Fax
(703) 444-9344
NPI assigned
Jul 1, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0401413641 VA Primary

Addresses

Primary practice location

14 Pidgeon Hill Dr Ste 200
Sterling, VA 20165-6133

Mailing address

14 Pidgeon Hill Dr Ste 200
Sterling, VA 20165-6133
Phone (703) 444-4104

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

State licenses

LicenseStateTypeSpecialty
0401413641VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Callahan Dental Dentist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1205064987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 PIDGEON HILL DR STE 200",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201656133",
            "telephone_number": "703-444-4104",
            "fax_number": "703-444-9344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 PIDGEON HILL DR STE 200",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201656133",
            "telephone_number": "703-444-4104",
            "fax_number": "703-444-9344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNIN",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-01",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401413641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.