San Dimas Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

44495 Issued in CA

Legal business name

SAN DIMAS PERIODONTICS

Practice address

1111 W Covina Blvd Ste 220
San Dimas, CA 91773-3205

Phone

(909) 599-9510

Fax

(909) 599-1610

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mohamed Ihsan Kayali, D.D.S.NPI 1477612406

Title

President

Phone

(909) 599-9510

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohamed Ihsan Kayali, D.D.S.

  • Periodontics
  • San Dimas, CA
  • NPI 1477612406
  NPD (past) Authorized official

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033261391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W COVINA BLVD STE 220",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733205",
            "telephone_number": "909-599-9510",
            "fax_number": "909-599-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W COVINA BLVD STE 220",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733205",
            "telephone_number": "909-599-9510",
            "fax_number": "909-599-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIMAS PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAYALI",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "IHSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-599-9510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "44495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Dimas Family Care Inc.
• San Dimas Family Care, a Medical Corporation (San Dimas Family Care)
• San Dimas Family Clinic
• San Dimas Operations, LLC
• San Dimas Pathology Associates
• San Dimas Physical Therapy, Inc
• San Dimas Retirement Center LLC (San Dimas Retirement Center)
• San Dimas Surgical Medical Center
• San Dimas Surgical Medical Center Institute Inc.
• San Gabriel Valley Surgical Medical GRP, Inc

• Periodontics in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.