Individual provider Active NPI

Bindu B. Kansagra, DDS

  • Dentist
  • Tustin, CA
National Provider Identifier
1477703304
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
57691 Issued in CA
Practice address
14382 Red Hill Ave Apt 21
Tustin, CA 92780-6267
Phone
(714) 679-9883
NPI assigned
Sep 29, 2008
Last updated
Feb 6, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.025643 OH
Dentist 122300000X 57691 CA Primary

Addresses

Primary practice location

14382 Red Hill Ave Apt 21
Tustin, CA 92780-6267

Mailing address

14382 Red Hill Ave
Unit #21
Tustin, CA 92780
Phone (714) 679-9883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150812009089 CA Order and Referring Only - DentistPractitioner - Dentist 1658686175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30.025643OHMDDentist
57691CAMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1477703304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14382 RED HILL AVE",
            "address_2": "UNIT #21",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "92780",
            "telephone_number": "714-679-9883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14382 RED HILL AVE APT 21",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806267",
            "telephone_number": "714-679-9883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANSAGRA",
        "first_name": "BINDU",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.025643",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.