Active NPI
Divakar Prakash
- Dentist
- Turlock, CA
National Provider Identifier
1265911622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 102866
- Practice address
- 2808 W Monte Vista Ave
Turlock, CA 95380-8409 - Phone
- (415) 316-5396
- NPI assigned
- Aug 7, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 102866 | CA | Primary |
Addresses
Primary practice location
2808 W Monte Vista Ave
Turlock, CA 95380-8409
Mailing address
400 Clementina St Apt 408
San Francisco, CA 94103-4254
Phone (415) 316-5396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102866 | Other | CA | DENTAL BOARD OF CALIFORNIA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181105003371 | CA | Order and Referring Only - Dentist | 4688927833 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102866 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533600000000",
"number": "1265911622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 CLEMENTINA ST APT 408",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941034254",
"telephone_number": "415-316-5396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2808 W MONTE VISTA AVE",
"city": "TURLOCK",
"state": "CA",
"postal_code": "953808409",
"telephone_number": "415-316-5396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRAKASH",
"first_name": "DIVAKAR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2018-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "102866",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BOARD OF CALIFORNIA",
"identifier": "102866",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Turlock, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.