Active NPI
Dwayne Kim Martin, DDS
- Periodontics
- Walnut Creek, CA
National Provider Identifier
1558446773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 25171
- Practice address
- 1855 San Miguel Dr
Suite 21
Walnut Creek, CA 94596-5279 - Phone
- (925) 932-1422
- Fax
- (925) 932-2020
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 25171 | CA | Primary |
Addresses
Primary practice location
1855 San Miguel Dr
Suite 21
Walnut Creek, CA 94596-5279
Mailing address
1855 San Miguel Dr
Suite 21
Walnut Creek, CA 94596-5279
Phone (925) 932-1422
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25171 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335916800000",
"number": "1558446773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1855 SAN MIGUEL DR",
"address_2": "SUITE 21",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965279",
"telephone_number": "925-932-1422",
"fax_number": "925-932-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1855 SAN MIGUEL DR",
"address_2": "SUITE 21",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965279",
"telephone_number": "925-932-1422",
"fax_number": "925-932-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "DWAYNE",
"middle_name": "KIM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2012-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "25171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.