Active NPI
Dimitra Kokkalis Wagner
- Specialist
- San Francisco, CA
National Provider Identifier
1710390919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A172034
- Practice address
- 324 W Portal Ave
San Francisco, CA 94127-1412 - Phone
- (415) 731-8080
- NPI assigned
- Jun 4, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | A172034 | CA | Primary |
Addresses
Primary practice location
324 W Portal Ave
San Francisco, CA 94127-1412
Mailing address
324 W Portal Ave
San Francisco, CA 94127-1412
Phone (415) 731-8080
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 |
|---|---|---|---|
| A172034 | CA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401840000000",
"number": "1710390919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 W PORTAL AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941271412",
"telephone_number": "415-731-8080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 W PORTAL AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941271412",
"telephone_number": "415-731-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DIMITRA",
"middle_name": "KOKKALIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-04",
"last_updated": "2014-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "CA",
"license": "A172034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.