Active NPI
Keisuke Wada, DMD
- Periodontics
- Philadelphia, PA
National Provider Identifier
1376897793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS039376
- Practice address
- 3401 Market Street
Suite 110
Philadelphia, PA 19104 - Phone
- (215) 573-8400
- NPI assigned
- Nov 7, 2012
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS039376 | PA | Primary |
Addresses
Primary practice location
3401 Market Street
Suite 110
Philadelphia, PA 19104
Mailing address
150 E Wynnewood Rd
#2A
Wynnewood, PA 19096
Phone (610) 649-0570
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
| License | State | Type | Specialty |
|---|---|---|---|
| DS039376 | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352246400000",
"number": "1376897793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 E WYNNEWOOD RD",
"address_2": "#2A",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "19096",
"telephone_number": "610-649-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 MARKET STREET",
"address_2": "SUITE 110",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-573-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADA",
"first_name": "KEISUKE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-07",
"last_updated": "2012-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS039376",
"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 Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.