Active NPI
Madhav Mukundan, D.D.S
- General Practice Dentistry
- Watsonville, CA
National Provider Identifier
1619155587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 59239
- Practice address
- 1053 S Green Valley Rd
Watsonville, CA 95076-4164 - Phone
- (831) 515-3006
- NPI assigned
- Feb 3, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 59239 | CA | Primary |
Addresses
Primary practice location
1053 S Green Valley Rd
Watsonville, CA 95076-4164
Mailing address
300 Glenwood Cir Apt 214
Monterey, CA 93940-4710
Phone (917) 385-0549
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59239 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389571200000",
"number": "1619155587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 GLENWOOD CIR APT 214",
"city": "MONTEREY",
"state": "CA",
"postal_code": "939404710",
"telephone_number": "917-385-0549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1053 S GREEN VALLEY RD",
"city": "WATSONVILLE",
"state": "CA",
"postal_code": "950764164",
"telephone_number": "831-515-3006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKUNDAN",
"first_name": "MADHAV",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-03",
"last_updated": "2014-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "59239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watsonville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.