Active NPI
Steve H Bolur, DDS
- Dentist
- West Los Angeles, CA
National Provider Identifier
1003022211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 37316
- Practice address
- 12113 Santa Monica Blvd
Suite 204
West Los Angeles, CA 90025 - Phone
- (310) 571-3000
- Fax
- (310) 571-3309
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 37316 | CA | Primary |
Addresses
Primary practice location
12113 Santa Monica Blvd
Suite 204
West Los Angeles, CA 90025
Mailing address
12113 Santa Monica Blvd
Suite 204
West Los Angeles, CA 90025
Phone (310) 571-3000
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 |
|---|---|---|---|
| 37316 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003022211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12113 SANTA MONICA BLVD",
"address_2": "SUITE 204",
"city": "WEST LOS ANGELES",
"state": "CA",
"postal_code": "90025",
"telephone_number": "310-571-3000",
"fax_number": "310-571-3309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12113 SANTA MONICA BLVD",
"address_2": "SUITE 204",
"city": "WEST LOS ANGELES",
"state": "CA",
"postal_code": "90025",
"telephone_number": "310-571-3000",
"fax_number": "310-571-3309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLUR",
"first_name": "STEVE",
"middle_name": "H",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "37316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.