Active NPI
Kenneth D Dykstra, MD
- Pediatric Endocrinology Physician
- Wichita, KS
National Provider Identifier
1710916341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Endocrinology Physician
- License
- 28093
- Practice address
- 3243 E Murdock St
Suite #500
Wichita, KS 67208-3052 - Phone
- (316) 962-2080
- Fax
- (316) 962-2079
- NPI assigned
- Jul 3, 2006
- Last updated
- Feb 3, 2012
- 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 |
|---|---|---|---|---|
| Pediatric Endocrinology Physician | 2080P0205X | 28093 | KS | Primary |
Addresses
Primary practice location
3243 E Murdock St
Suite #500
Wichita, KS 67208-3052
Mailing address
3243 E Murdock St
Suite #500
Wichita, KS 67208-3052
Phone (316) 962-2080
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 055541 | Other | KS | BCBS |
| 11872 | Other | KS | PHS |
| 12149357 | Other | KS | MULTIPLAN |
| 200626 | Other | KS | HPK |
| 100333960A | Medicaid | KS | |
| 16997 | Other | KS | COVENTRY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28093 | KS | MD | Pediatric Endocrinology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328227200000",
"number": "1710916341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3243 E MURDOCK ST",
"address_2": "SUITE #500",
"city": "WICHITA",
"state": "KS",
"postal_code": "672083052",
"telephone_number": "316-962-2080",
"fax_number": "316-962-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3243 E MURDOCK ST",
"address_2": "SUITE #500",
"city": "WICHITA",
"state": "KS",
"postal_code": "672083052",
"telephone_number": "316-962-2080",
"fax_number": "316-962-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYKSTRA",
"first_name": "KENNETH",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2012-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "KS",
"license": "28093",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "055541",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHS",
"identifier": "11872",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "12149357",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPK",
"identifier": "200626",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100333960A",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "16997",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.