Individual provider Active NPI

Ghassan Adnan Jabbar Jayyar, DMD

  • Dentist
  • San Diego, CA
National Provider Identifier
1003528738
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
108429 Issued in CA
Practice address
286 Euclid Ave Ste 201
San Diego, CA 92114-3612
Phone
(619) 263-6683
NPI assigned
Dec 13, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 108429 CA Primary

Addresses

Primary practice location

286 Euclid Ave Ste 201
San Diego, CA 92114-3612

Mailing address

10111 Mars CT
Spring Valley, CA 91977-7147
Phone (619) 383-4645

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230821002589 CA Practitioner - Maxillofacial SurgeryPractitioner - Oral SurgeryPractitioner - Dentist 3779945878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
108429CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ghassan Jayyar DDS PC Current Accepting new patients
Gene P. Moore DDS PastSince Dec 18, 2022 Accepting new patients

Locations

13465 Camino Canada
Ste 110A
El Cajon, CA 92021
Phone (619) 390-3669

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1003528738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10111 MARS CT",
            "city": "SPRING VALLEY",
            "state": "CA",
            "postal_code": "919777147",
            "telephone_number": "619-383-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 EUCLID AVE STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921143612",
            "telephone_number": "619-263-6683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYYAR",
        "first_name": "GHASSAN",
        "middle_name": "ADNAN JABBAR",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-13",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "108429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.