Nikita Feliksovich Kazak, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DDS102575 Issued in CA

Practice address

915 Sir Francis Drake Blvd Ste 1
San Anselmo, CA 94960-1946

Phone

(415) 454-5667

NPI assigned

Jul 26, 2018

Sex

Male

Sole proprietor

No

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kazak Dental Corp

  • Dental Clinic/Center
  • San Anselmo, CA
  • NPI 1841945490
  NPD

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1891272399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 44TH AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941221104",
            "telephone_number": "415-652-9916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SIR FRANCIS DRAKE BLVD STE 1",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949601946",
            "telephone_number": "415-454-5667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2660 5th St Ste C",
            "address_purpose": "LOCATION",
            "city": "Alameda",
            "state": "CA",
            "postal_code": "94501",
            "country_code": "US",
            "telephone_number": "510-384-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAZAK",
        "first_name": "NIKITA",
        "middle_name": "FELIKSOVICH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-26",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS102575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan L Jones
• Barbara Theiss Juniper
• Mured Kakar, ABO
• Kathleen McDonough Physical Therapy Associates PC
• Kazak Dental Corp
• Heidi Jane Keller, M.S, D.C.
• Cara Jean Kerby, LPCC, LAADC
• Nicholas G Kerry, O.D.
• Bruce Andrew Killen, MFT
• Judith Kinsinger, L.AC

• Dentist in San Anselmo, CA
• Providers in San Anselmo, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.