Venkat Yashaswi Kondapalli

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019031291 Issued in IL

Practice address

1200 W Main St Ste 9
Peoria, IL 61606-1218

Phone

(309) 777-9777

NPI assigned

Jul 31, 2017

Last updated

Jul 31, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Access Dental of Peoria Optim LLC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1437818242
  NPD (past)
• Optim Dental Peoria-1 LLC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1962943290
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501459200000",
    "number": "1740704832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9701 N LANTANA LN APT 10201",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157421",
            "telephone_number": "716-430-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W MAIN ST STE 9",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061218",
            "telephone_number": "309-777-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDAPALLI",
        "first_name": "VENKAT YASHASWI",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019031291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Koeppen, MD
• Truc-Quynh D Kohlmeyer
• Stephanie Kok, M.D.
• Jennifer Lee Kolettis, NP-C
• Yannis N Kolettis, M.D.
• Derek Koon
• Kathleen Koors
• Christopher Kopan
• Gretchen L Kopec, M.D.
• Drew Dempsie Kortus, MD

• General Practice Dentistry in Peoria, IL
• Providers in Peoria, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.