Benjamin Andrew Kordusky, DDS, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

106157 Issued in CA

Practice address

8415 Elk Grove Blvd BLDG B
Elk Grove, CA 95758-9573

Phone

(916) 755-6213

Fax

(916) 755-6214

NPI assigned

Jun 13, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1417487513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 FAIRFIELD MNR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265058011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8415 ELK GROVE BLVD BLDG B",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957589573",
            "telephone_number": "916-755-6213",
            "fax_number": "916-755-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDUSKY",
        "first_name": "BENJAMIN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WV",
            "license": "4269",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "106157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spien Ghar Komak, BS, MD
• Edmund Kong, PHARMD
• Sarah Kong
• Kirsten Alexis Konkel, M.S., CCC-SLP
• Christiana S Kopf, M.D.
• Samantha Paola Korhummel
• Einari Korth
• Jesse Koskey, MD
• Phillip Kostyuk, MS, CCC-SLP
• Rachana Neelum Sukhnandan Koura, M.D.

• Prosthodontics in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.