Mary Jo Kasenchak, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS040790 Issued in PA

Practice address

2144 Cecil B Moore Ave
Philadelphia, PA 19121-4014

Phone

(215) 320-6187

NPI assigned

May 26, 2016

Sex

Female

Sole proprietor

Yes

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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481760000000",
    "number": "1780032136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 CECIL B MOORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191214014",
            "telephone_number": "215-320-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 CECIL B MOORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191214014",
            "telephone_number": "215-320-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASENCHAK",
        "first_name": "MARY JO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS040790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasama Philly
• Anoosha Kasanagottu, DO
• Tammaris Rivera Kaschak, FNP-BC, AGACNP-BC
• Adrian Kase, MD
• Medina Kasemi, CRNP
• Megan Kasetty, MD
• Natalia Kashitsyna, MSN, APRN, FNP-C
• Nancy Lynn Kashlak, RN,CPNP,MSN
• Paul Kashmanian, PA
• Kimberly Kashner

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; 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.

Verify at the official NPI Registry.