Individual provider Active NPI

Michelle Kasimi, DMD

  • General Practice Dentistry
  • San Jose, CA
National Provider Identifier
1467169300
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
108307 Issued in CA
Practice address
6529 Crown Blvd Ste B
San Jose, CA 95120-2905
Phone
(408) 997-1251
NPI assigned
Oct 31, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 108307 CA Primary

Addresses

Primary practice location

6529 Crown Blvd Ste B
San Jose, CA 95120-2905

Mailing address

450 San Antonio Rd Apt 1409
Mountain View, CA 94040-1794
Phone (503) 916-9975

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

LicenseStateTypeSpecialty
108307CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Vidya Bobba, DMD, Inc. General Practice PastSince Nov 6, 2022 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1467169300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 SAN ANTONIO RD APT 1409",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940401794",
            "telephone_number": "503-916-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6529 CROWN BLVD STE B",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951202905",
            "telephone_number": "408-997-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASIMI",
        "first_name": "MICHELLE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.