Active NPI
Radhika Manthina
- Dentist
- San Jose, CA
National Provider Identifier
1508054982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 55821
- Practice address
- 4522 Hamilton Ave
#3
San Jose, CA 95130-1424 - Phone
- (408) 396-7377
- NPI assigned
- Oct 10, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 55821 | CA | Primary |
Addresses
Primary practice location
4522 Hamilton Ave
#3
San Jose, CA 95130-1424
Mailing address
4522 Hamilton Ave
#3
San Jose, CA 95130-1424
Phone (408) 396-7377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D55821 | Medicaid | CA |
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 |
|---|---|---|---|
| 55821 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205193600000",
"number": "1508054982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4522 HAMILTON AVE",
"address_2": "#3",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951301424",
"telephone_number": "408-396-7377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4522 HAMILTON AVE",
"address_2": "#3",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951301424",
"telephone_number": "408-396-7377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTHINA",
"first_name": "RADHIKA",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-10",
"last_updated": "2008-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "55821",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D55821",
"state": "CA"
}
],
"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 Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.