NPIMap

Organization Active NPI

Sanjay Kandoth MD PC

Doing business as Sunrise Pediatrics

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1558806570
Registry record updated Dec 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9350 Issued in NV
Legal business name
SANJAY KANDOTH MD PC
Doing business as
Sunrise Pediatrics
Practice address
7200 Smoke Ranch Rd
Suite 150
Las Vegas, NV 89128-1115
Phone
(702) 820-5437
Fax
(702) 254-7354
NPI assigned
Dec 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2016

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

Authorized official

Name
Dr. Sanjay W Kandoth, MD
Title
President
Phone
(702) 254-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 9350 NV Primary

Addresses

Primary practice location

7200 Smoke Ranch Rd
Suite 150
Las Vegas, NV 89128-1115

Mailing address

3061 S Maryland Pkwy
Ste 101
Las Vegas, NV 89109-2298
Phone (702) 254-5437

Other names 1

  • Sunrise Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2125879Sunrise Pediatrics Smoke Ranch7200 Smoke Ranch Rd Ste 150, Las Vegas, NV 89128Certificate of waiverFeb 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sanjay Kandoth MD PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7875 S Rainbow Blvd
Ste 102
Las Vegas, NV 89139
Phone (702) 254-5437

7200 Smoke Ranch Rd
Ste 150
Las Vegas, NV 89128
Phone (702) 820-5437

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1558806570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 S MARYLAND PKWY",
            "address_2": "STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092298",
            "telephone_number": "702-254-5437",
            "fax_number": "702-254-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 SMOKE RANCH RD",
            "address_2": "SUITE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281115",
            "telephone_number": "702-820-5437",
            "fax_number": "702-254-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANJAY KANDOTH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "KANDOTH",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-254-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "9350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.