Healthcare Provider Details

I. General information

NPI: 1689967119
Provider Name (Legal Business Name): JACOB B GOLDSTEIN DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CLAIRBORNE RD STE 201
OLATHE KS
66062-1735
US

IV. Provider business mailing address

401 S CLAIRBORNE RD STE 201
OLATHE KS
66062-1735
US

V. Phone/Fax

Practice location:
  • Phone: 913-856-8150
  • Fax: 913-856-8390
Mailing address:
  • Phone: 913-856-8150
  • Fax: 913-856-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB B GOLDSTEIN
Title or Position: OWNER
Credential: D.P.M.
Phone: 913-856-8150