NPIMap

Organization Active NPI

Herawati T Kandou DDS PA

  • Dentist
  • Warren, NJ
National Provider Identifier
1245499847
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9708 Issued in NJ
Legal business name
HERAWATI T KANDOU DDS PA
Practice address
163 Washington Valley Rd Ste 106
Washington Valley Office Park
Warren, NJ 07059-7181
Phone
(732) 560-5988
Fax
(732) 563-6999
NPI assigned
Jun 9, 2008
Organization subpart
Yes
Parent organization
HERAWATI T KANDOU DDS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Dr. Herawati T Kandou, DDS
Title
President Orthodontist
Phone
(732) 560-5988

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 9708 NJ Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 3026 NJ

Addresses

Primary practice location

163 Washington Valley Rd Ste 106
Washington Valley Office Park
Warren, NJ 07059-7181

Mailing address

163 Washington Valley Rd Ste 106
Washington Valley Office Park
Warren, NJ 07059-7181
Phone (732) 560-5988

National Provider Directory

National Provider Directory
Tax ID family
Herawati T Kandou DDS PA2 organizations share this tax ID, including this one
Part of
Herawati T Kandou DDS PA

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

163 Washington Valley Rd
Ste 106
Warren, NJ 07059
Phone (732) 560-5988

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1245499847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 WASHINGTON VALLEY RD STE 106",
            "address_2": "WASHINGTON VALLEY OFFICE PARK",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070597181",
            "telephone_number": "732-560-5988",
            "fax_number": "732-563-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 WASHINGTON VALLEY RD STE 106",
            "address_2": "WASHINGTON VALLEY OFFICE PARK",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070597181",
            "telephone_number": "732-560-5988",
            "fax_number": "732-563-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERAWATI T KANDOU DDS PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERAWATI T KANDOU DDS PA",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "KANDOU",
        "authorized_official_first_name": "HERAWATI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT ORTHODONTIST",
        "authorized_official_telephone_number": "732-560-5988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "9708",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "3026",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.