Active NPI
Kaynaz Myrum
- Pediatric Dentistry
- Philadelphia, PA
National Provider Identifier
1467898601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS039523
- Practice address
- 2459 Aramingo Ave
Philadelphia, PA 19125-3731 - Phone
- (215) 427-2800
- NPI assigned
- May 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS039523 | PA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | DS039523 | PA | Primary |
Addresses
Primary practice location
2459 Aramingo Ave
Philadelphia, PA 19125-3731
Mailing address
200 Willowbrook LN Ste 220
West Chester, PA 19382-5697
Other practice location 1
130 S State Rd Ste 300
Springfield, PA 19064-1232
Phone (610) 622-1949
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Myru0008@umn.edu |
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 |
|---|---|---|---|
| DS039523 | PA | MD | Dentist |
Interoperability endpoints
- myru0008@umn.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1467898601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WILLOWBROOK LN STE 220",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193825697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2459 ARAMINGO AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191253731",
"telephone_number": "215-427-2800"
}
],
"practiceLocations": [
{
"address_1": "130 S State Rd Ste 300",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "PA",
"postal_code": "190641232",
"country_code": "US",
"telephone_number": "610-622-1949",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MYRUM",
"first_name": "KAYNAZ",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-15",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS039523",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS039523",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Myru0008@umn.edu",
"affiliation": "N",
"address_1": "130 S State Rd Ste 300",
"city": "Springfield",
"state": "PA",
"country_code": "US",
"postal_code": "190641232",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.