Sushma Mangalavarapet Kantharaju, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

DDS100731 Issued in CA

Practice address

4053 E Morada LN
Stockton, CA 95212-1608

Phone

(209) 478-6000

NPI assigned

Oct 16, 2016

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1476576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476576000000",
    "number": "1982155834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4053 E MORADA LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952121608",
            "telephone_number": "209-478-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4053 E MORADA LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952121608",
            "telephone_number": "209-478-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGALAVARAPET KANTHARAJU",
        "first_name": "SUSHMA",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-16",
        "last_updated": "2016-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS100731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aniruddh Mandalapu
• Mandeep Singh M D Inc
• Jennifer L Manduca
• Bailey T Manego
• Marda M Manfre
• Cathy Dinice Mangaoang-Welsh, LCSW
• Jussein Rigor Mangondato, M.D.
• Linda Mangrum
• Natalie Mangrum, M.S. CCC-SLP
• Sampathkumar Mani, MD

• Dentist in Stockton, CA
• Providers in Stockton, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2016; 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.