Active NPI
Goutam Krish
- Dental Anesthesiology
- Walnut Creek, CA
National Provider Identifier
1417541459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 2193
- Practice address
- 1916 Apollo CT
Walnut Creek, CA 94598-2249 - Phone
- (805) 791-1454
- NPI assigned
- Feb 20, 2021
- Last updated
- Oct 8, 2024
- 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 |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | 2193 | CA | Primary |
Addresses
Primary practice location
1916 Apollo CT
Walnut Creek, CA 94598-2249
Mailing address
1916 Apollo CT
Walnut Creek, CA 94598-2249
Phone (805) 791-1454
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 |
|---|---|---|---|
| 2193 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728345600000",
"number": "1417541459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1916 APOLLO CT",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945982249",
"telephone_number": "805-791-1454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1916 APOLLO CT",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945982249",
"telephone_number": "805-791-1454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISH",
"first_name": "GOUTAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-20",
"last_updated": "2024-10-08",
"certification_date": "2024-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "CA",
"license": "2193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.