Individual provider Active NPI

Kumudini Panchal, D.M.D.

  • General Practice Dentistry
  • Mission Viejo, CA
National Provider Identifier
1861708778
Registry record updated Nov 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
59679 Issued in CA
Practice address
27762 Vista del Lago Ste a-9
Mission Viejo, CA 92692-1137
Phone
(949) 859-3109
NPI assigned
Aug 30, 2010
Last updated
Nov 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 203315 CO
General Practice Dentistry 1223G0001X 59679 CA Primary

Addresses

Primary practice location

27762 Vista del Lago Ste a-9
Mission Viejo, CA 92692-1137

Mailing address

27762 Vista del Lago Ste a-9
Mission Viejo, CA 92692-1137

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20150812009242 CA Order and Referring Only - DentistPractitioner - Dentist 7517272032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
203315COMDGeneral Practice Dentistry
59679CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
K Panchal Dental Corporation CurrentSince Sep 1, 2025 Accepting new patients
Reagan Dental Corporation General Practice PastSince Oct 2, 2022 Accepting new patients

Locations

27762 Vista del Lago
Ste A9
Mission Viejo, CA 92692
Phone (949) 859-3109

Organizations & group practices 2

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": "1283126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762041600000",
    "number": "1861708778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27762 VISTA DEL LAGO STE A-9",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926921137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27762 VISTA DEL LAGO STE A-9",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926921137",
            "telephone_number": "949-859-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHAL",
        "first_name": "KUMUDINI",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-30",
        "last_updated": "2025-11-02",
        "certification_date": "2025-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "203315",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.