Active NPI
Anthony Gediminas Matukas, MD
- Dermatology Physician
- San Jose, CA
National Provider Identifier
1669469003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G11143
- Practice address
- 2505 Samaritan Dr
601
San Jose, CA 95124-4006 - Phone
- (408) 358-1717
- Fax
- (408) 358-1718
- NPI assigned
- Sep 30, 2005
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | G11143 | CA | Primary |
Addresses
Primary practice location
2505 Samaritan Dr
601
San Jose, CA 95124-4006
Mailing address
2505 Samaritan Dr
601
San Jose, CA 95124-4006
Phone (408) 358-1717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160415001859 | CA | Order and Referring Only - Dermatology | 4587746656 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G11143 | CA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1669469003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2505 SAMARITAN DR",
"address_2": "601",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951244006",
"telephone_number": "408-358-1717",
"fax_number": "408-358-1718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 SAMARITAN DR",
"address_2": "601",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951244006",
"telephone_number": "408-358-1717",
"fax_number": "408-358-1718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATUKAS",
"first_name": "ANTHONY",
"middle_name": "GEDIMINAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "G11143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.