Keith L Radack, DR.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D23024 Issued in CA

Practice address

2625 W Alameda Ave
Suite 200
Burbank, CA 91505

Phone

(818) 845-2616

Fax

(818) 845-3359

NPI assigned

Feb 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 17, 2014 through Mar 17, 2028

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382659200000",
    "number": "1609915412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 W ALAMEDA AVE",
            "address_2": "SUITE 200",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91505",
            "telephone_number": "818-845-2616",
            "fax_number": "818-845-3359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 W ALAMEDA AVE",
            "address_2": "SUITE 200",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91505",
            "telephone_number": "818-845-2616",
            "fax_number": "818-845-3359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADACK",
        "first_name": "KEITH",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "DR.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2013-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "D23024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Burbank, CA
• Providers in Burbank, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.