Supriya Kumar Vaderhobli, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

50769 Issued in CA

Practice address

331 Inverness Dr
Pacifica, CA 94044-1712

Phone

(650) 359-1062

NPI assigned

Dec 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Supriya Kumar Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 12, 2015 through Sep 12, 2027

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.

• Polly Chan DDS Inc

  • Dentist
  • Foster City, CA
  • NPI 1508931247
  NPD (past)

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1336209626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 INVERNESS DR",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940441712",
            "telephone_number": "650-359-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 INVERNESS DR",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940441712",
            "telephone_number": "650-359-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VADERHOBLI",
        "first_name": "SUPRIYA",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-09",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUPRIYA",
            "last_name": "KUMAR",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dan Thy Tran, OD
• Holly Trief, VMD
• Unveil the Wellness Center
• Nancy Dayrit Uy
• Donna Johnson Uzoigwe, MS
• Sepideh Vafi, DDS
• Nicole Catherine Valadao, LCSW
• Azteca Linda Rita Valdez, CAS
• Erica Yoselina Valencia
• Suzanne Marie Valente, DDS

• Dentist in Pacifica, CA
• Providers in Pacifica, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.