Individual provider Active NPI

Rajeshwerrao Kokkirala, D.D.S

  • General Practice Dentistry
  • Bronx, NY
National Provider Identifier
1790867646
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
037203 Issued in NY
Practice address
1418 Wythe Place
Ground Floor
Bronx, NY 10452
Phone
(718) 681-8901
NPI assigned
Oct 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 037203 NY Primary

Addresses

Primary practice location

1418 Wythe Place
Ground Floor
Bronx, NY 10452

Mailing address

115 N Harrison Ave
Congers, NY 10920-1900
Phone (718) 681-8901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20160114000453 NY Order and Referring Only - DentistPractitioner - Dentist 7719280304

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
037203NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Firo Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790867646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N HARRISON AVE",
            "city": "CONGERS",
            "state": "NY",
            "postal_code": "109201900",
            "telephone_number": "718-681-8901",
            "fax_number": "718-681-8901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 WYTHE PLACE",
            "address_2": "GROUND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10452",
            "telephone_number": "718-681-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOKKIRALA",
        "first_name": "RAJESHWERRAO",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "037203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.