Vidya Kini Kukkundur, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02387200 Issued in NJ

Practice address

525 Route 73 S Ste 105
Marlton, NJ 08053-9643

Phone

(856) 596-4333

Fax

(856) 596-1726

NPI assigned

Sep 5, 2008

Last updated

Oct 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vidya Kini Kukkundur, DDS PC

  dba South Jersey Center for Dental Medicine

  • Dentist
  • Marlton, NJ
  • NPI 1003582883
  NPD Authorized official

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

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635552000000",
    "number": "1366690034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 S STE 105",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080539643",
            "telephone_number": "856-872-2622",
            "fax_number": "856-596-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 S STE 105",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080539643",
            "telephone_number": "856-596-4333",
            "fax_number": "856-596-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINI KUKKUNDUR",
        "first_name": "VIDYA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-05",
        "last_updated": "2021-10-30",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02387200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Joseph Killeen III, M.D.
• Lenore Killian-Norris, D.M.D.
• Ruth Ann Kilmer, RN, RNFA, CNOR, BSN
• Alvin Kingcade, PA-C
• Kingsway Services, Inc.
• Haley Kircher
• Kirshner Spine Institute, LLC
• Steven B Kirshner, M.D.
• Harris L Klear, D.P.M.
• Kleinbrook Counseling Services, Inc.

• General Practice Dentistry in Marlton, NJ
• Providers in Marlton, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2021; 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.

Verify at the official NPI Registry.