Keerthi Golla, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

052386 Issued in NY

Practice address

539 Madison Ter
Sunnyvale, CA 94087-4872

Phone

(732) 648-1166

Fax

(732) 648-1166

NPI assigned

Dec 26, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1528045184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 MADISON TER",
            "city": "SUNNYVALE",
            "state": "CA",
            "postal_code": "940874872",
            "telephone_number": "732-648-1166",
            "fax_number": "732-648-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 MADISON TER",
            "city": "SUNNYVALE",
            "state": "CA",
            "postal_code": "940874872",
            "telephone_number": "732-648-1166",
            "fax_number": "732-648-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLA",
        "first_name": "KEERTHI",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-26",
        "last_updated": "2021-04-06",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "100398",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021002442",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02678619",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radha Murali Gomatam, RPH
• Dom Ernest L Gomez, DPT
• Gordon Gee Gong, DMD
• Vivian Gong, DDS
• Bianca Gonzalez, NP

• General Practice Dentistry in Sunnyvale, CA
• Providers in Sunnyvale, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; 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.