Soumya Shivanna, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55657 Issued in CA

Practice address

1620 E.Capitol Expressway
Suite C
San Jose, CA 95121

Phone

(408) 223-6017

Fax

(408) 223-6019

NPI assigned

Mar 18, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Soumya Shivanna Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: sshivanna@direct.westerndental.com

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1598936676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 E. CAPITOL EXPRESSWAY, SUITE C",
            "address_2": "EVERGREEN FAMILY DENTAL GROUP",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95121",
            "telephone_number": "408-223-6017",
            "fax_number": "408-223-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 E.CAPITOL EXPRESSWAY",
            "address_2": "SUITE C",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95121",
            "telephone_number": "408-223-6017",
            "fax_number": "408-223-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVANNA",
        "first_name": "SOUMYA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-18",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOUMYA",
            "last_name": "SHIVANNA",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lisa Y Shiroishi, O.D.
• Shirzadi, M.D. Inc
• Neda Shirzadi, MD
• Stason K. Shishido, D.D.S
• Supreeth Shivakanth, L.AC
• Saundra K. Shiver
• Carly Rachel Shless
• Lana Shmurakov, DDS
• Nataliya B Shnayder, RN
• Marina Alex Shnaydman, DDS

• General Practice Dentistry in San Jose, CA
• Providers in San Jose, 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 Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.