Active NPI
David Paul Kumamoto, D.D.S.
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1417022955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19A-15501
- Practice address
- 6424 N Northwest Hwy
Chicago, IL 60631-1450 - Phone
- (773) 763-5030
- Fax
- (847) 965-4603
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 19A-15501 | IL | Primary |
Addresses
Primary practice location
6424 N Northwest Hwy
Chicago, IL 60631-1450
Mailing address
6424 Northwest Highway
Chicago, IL 60631-1450
Phone (773) 763-5030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19A-15501 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436832000000",
"number": "1417022955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6424 NORTHWEST HIGHWAY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606311450",
"telephone_number": "773-763-5030",
"fax_number": "312-583-1825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6424 N NORTHWEST HWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606311450",
"telephone_number": "773-763-5030",
"fax_number": "847-965-4603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUMAMOTO",
"first_name": "DAVID",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2015-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "19A-15501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.