NPIMap

Organization Active NPI

Larissa Gushansky, DDS Inc.

  • Dentist
  • Pomona, CA
National Provider Identifier
1003000928
Registry record updated Sep 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
36156 Issued in CA
Legal business name
LARISSA GUSHANSKY, DDS INC.
Practice address
887 E 2ND St
Suite B
Pomona, CA 91766-2009
Phone
(909) 865-8595
NPI assigned
Sep 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2007

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

Authorized official

Name
Dr. Larissa Gushansky
Title
President
Phone
(323) 563-9124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 36156 CA Primary

Addresses

Primary practice location

887 E 2ND St
Suite B
Pomona, CA 91766-2009

Mailing address

887 E 2ND St
Suite B
Pomona, CA 91766-2009
Phone (909) 865-8595

Other identifiers 1

IdentifierTypeStateIssuer
B36156-02OtherCADENTI-CAL

National Provider Directory

National Provider Directory
Tax ID family
Larissa Gushansky DDS Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

887 E 2nd St
Ste B
Pomona, CA 91766
Phone (909) 865-8595

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1003000928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "887 E 2ND ST",
            "address_2": "SUITE B",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662009",
            "telephone_number": "909-865-8595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "887 E 2ND ST",
            "address_2": "SUITE B",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662009",
            "telephone_number": "909-865-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARISSA GUSHANSKY, DDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "GUSHANSKY",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-563-9124",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "36156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "B36156-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.