Dedicated Pennsylvania Holding, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DEDICATED PENNSYLVANIA HOLDING, LLC

Practice address

330 W Oregon Ave # 170
Philadelphia, PA 19148-4723

Phone

(305) 628-6117

NPI assigned

Dec 3, 2019

Organization subpart

Yes

Parent organization

DEDICATED PENNSYLVANIA HOLDING, LLCAs reported in NPPES

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

Authorized official

Name

Mary Chen

Title

Authorized Official

Phone

(305) 831-4722

Specialties & licenses 2

Addresses

Other names 1

• Dedicated Senior Medical Center South Philadelphia Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Dedicated PA Holding LLC2 organizations share this tax ID, including this one

Part of

Dedicated PA Holding LLC

Other organizations with this tax ID 1

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

• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1366950776
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1366950776
  NPPES parent name

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1023655602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W OREGON AVE # 170",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191484723",
            "telephone_number": "305-628-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED PENNSYLVANIA HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED PENNSYLVANIA HOLDING, LLC",
        "enumeration_date": "2019-12-03",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "305-831-4722"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center South Philadelphia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dedicated Senior Medical Center South Philadelphia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gayle Dede
• Kavita Dedhia, M.D.
• Raj Champak Dedhia, MD
• Dedicated Friend Home Care, LLC.
• Dedicated Hands 4 U LLC
• Dedicated Pennsylvania Holding, LLC
• Dedicated Pennsylvania Holding, LLC
• Dedicated Pennsylvania Holding, LLC
• Dedicated Pennsylvania Holding, LLC
• Dedicated Pennsylvania Holding, LLC

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.