Revanth Chada, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

10740 Issued in KY

Practice address

11212 Professional Park Dr
Louisville, KY 40291-4476

Phone

(612) 735-8159

NPI assigned

May 17, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1528415742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11212 PROFESSIONAL PARK DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402914476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11212 PROFESSIONAL PARK DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402914476",
            "telephone_number": "612-735-8159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHADA",
        "first_name": "REVANTH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-17",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13666",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "10740",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "KY",
            "license": "10740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yong Cha, MD, PHD
• Jignesh Chabhadiya
• Angela Chachere
• Chachos Helping Hands
• Chad Walters DO LLC
• Naga Chadalapaka, MD
• Jenna Chady
• Marlon R Chagua, M.D.
• Chaimllc
• Ali Chaker

• Endodontics in Louisville, KY
• Providers in Louisville, KY by specialty
• Endodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.