Active NPI
Warren Ken Shimotsu, DDS
- General Practice Dentistry
- Sunnyvale, CA
National Provider Identifier
1962774414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- CA 30863
- Practice address
- 665 S Knickerbocker Dr
Suite # 10
Sunnyvale, CA 94087-1033 - Phone
- (408) 720-0638
- NPI assigned
- Jan 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | CA 30863 | CA | Primary |
Addresses
Primary practice location
665 S Knickerbocker Dr
Suite # 10
Sunnyvale, CA 94087-1033
Mailing address
665 S Knickerbocker Dr
Suite # 10
Sunnyvale, CA 94087-1033
Phone (408) 720-0638
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA 30863 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327881600000",
"number": "1962774414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 S KNICKERBOCKER DR",
"address_2": "SUITE # 10",
"city": "SUNNYVALE",
"state": "CA",
"postal_code": "940871033",
"telephone_number": "408-720-0638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 S KNICKERBOCKER DR",
"address_2": "SUITE # 10",
"city": "SUNNYVALE",
"state": "CA",
"postal_code": "940871033",
"telephone_number": "408-720-0638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMOTSU",
"first_name": "WARREN",
"middle_name": "KEN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-30",
"last_updated": "2012-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "CA 30863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunnyvale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.