Individual provider Active NPI

Krishna P Kansagra, DDS

  • Pediatric Dentistry
  • Philadelphia, PA
National Provider Identifier
1306216882
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
64979 Issued in CA
Practice address
1500 Locust St Apt 3602
Philadelphia, PA 19102-4324
Phone
(909) 670-7777
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS042127 PA
Dentist 122300000X 64979 CA
Pediatric Dentistry 1223P0221X 64979 CA Primary

Addresses

Primary practice location

1500 Locust St Apt 3602
Philadelphia, PA 19102-4324

Mailing address

15389 Canon LN
Chino Hills, CA 91709-5239
Phone (909) 670-7777

Other practice location 1

15389 Canon Ln
Chino Hills, CA 91709-5239
Phone (909) 670-7777

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
64979CAMDDentist
DS042127PAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1306216882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15389 CANON LN",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095239",
            "telephone_number": "909-670-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LOCUST ST APT 3602",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191024324",
            "telephone_number": "909-670-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15389 Canon Ln",
            "address_purpose": "LOCATION",
            "city": "Chino Hills",
            "state": "CA",
            "postal_code": "917095239",
            "country_code": "US",
            "telephone_number": "909-670-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANSAGRA",
        "first_name": "KRISHNA",
        "middle_name": "P",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS042127",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64979",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "64979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.