Active NPI
Andriy Shevchuk, DDS
- General Practice Dentistry
- Occidental, CA
National Provider Identifier
1033403563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 60338
- Practice address
- 4066 Bohemian Hwy
Occidental, CA 95465 - Phone
- (909) 809-1069
- NPI assigned
- Jun 1, 2011
- Last updated
- Jun 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 60338 | CA | Primary |
Addresses
Primary practice location
4066 Bohemian Hwy
Occidental, CA 95465
Mailing address
PO Box 1163
Occidental, CA 95465-1163
Phone (909) 809-1069
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 |
|---|---|---|---|
| 60338 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1033403563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1163",
"city": "OCCIDENTAL",
"state": "CA",
"postal_code": "954651163",
"telephone_number": "909-809-1069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4066 BOHEMIAN HWY",
"city": "OCCIDENTAL",
"state": "CA",
"postal_code": "95465",
"telephone_number": "909-809-1069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEVCHUK",
"first_name": "ANDRIY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-01",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "60338",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Occidental, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.