Individual provider Active NPI

Marina Karnaukh, D.M.D.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1780097022
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019030422 Issued in IL
Practice address
4901 N Kedzie Ave
Chicago, IL 60625-5009
Phone
(773) 340-8318
NPI assigned
Jun 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 019030422 IL Primary

Addresses

Primary practice location

4901 N Kedzie Ave
Chicago, IL 60625-5009

Mailing address

1147 W Diversey Pkwy # 1
Chicago, IL 60614-1318
Phone (440) 668-6486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140801001684 ME Order and Referring Only - Maxillofacial SurgeryPractitioner - Maxillofacial Surgery 4183840853

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019030422ILMDGeneral Practice Dentistry

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": "1443398400000",
    "number": "1780097022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 W DIVERSEY PKWY # 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141318",
            "telephone_number": "440-668-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255009",
            "telephone_number": "773-340-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARNAUKH",
        "first_name": "MARINA",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019030422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.