NPIMap

Individual provider Active NPI

Sanjay W Kandoth, MD

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1821086190
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9350 Issued in NV
Practice address
3025 S Maryland Pkwy
Suite #B
Las Vegas, NV 89109-6221
Phone
(702) 254-5437
Fax
(702) 254-7354
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
No

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
Pediatrics Physician 208000000X 9350 NV Primary

Addresses

Primary practice location

3025 S Maryland Pkwy
Suite #B
Las Vegas, NV 89109-6221

Mailing address

PO Box 60515
Las Vegas, NV 89160-0515
Phone (702) 254-5437

Other identifiers 2

IdentifierTypeStateIssuer
002018417MedicaidNV
003102417MedicaidNV

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

LicenseStateTypeSpecialty
9350NVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Sanjay Kandoth MD PC Pediatrics Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Henderson Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Sanjay Kandoth MD PC Pediatrics Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Sanjay Kandoth MD PC Pediatrics Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4

Organizations & group practices 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821086190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60515",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891600515",
            "telephone_number": "702-254-5437",
            "fax_number": "702-254-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 S MARYLAND PKWY",
            "address_2": "SUITE #B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891096221",
            "telephone_number": "702-254-5437",
            "fax_number": "702-254-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDOTH",
        "first_name": "SANJAY",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "9350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018417",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003102417",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.