Active NPI
Mark Pacheco, D.D.S.
- Dentist
- San Jose, CA
National Provider Identifier
1710297601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 59830
- Practice address
- 5710 Cahalan Avenue
BLDG 6 Unit I
San Jose, CA 95123 - Phone
- (408) 784-3552
- NPI assigned
- Oct 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 59830 | CA | Primary |
Addresses
Primary practice location
5710 Cahalan Avenue
BLDG 6 Unit I
San Jose, CA 95123
Mailing address
PO Box 41093
San Jose, CA 95160-1093
Phone (408) 472-1134
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 |
|---|---|---|---|
| 59830 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547596800000",
"number": "1710297601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 41093",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951601093",
"telephone_number": "408-472-1134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5710 CAHALAN AVENUE",
"address_2": "BLDG 6 UNIT I",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95123",
"telephone_number": "408-784-3552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACHECO",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-14",
"last_updated": "2019-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "59830",
"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 Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.