Rupporn Priyawat

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

61647 Issued in CA

Practice address

15911 Pomona Rincon Rd Ste 120
Chino Hills, CA 91709-5567

Phone

(909) 497-9449

NPI assigned

Nov 20, 2012

Last updated

Jul 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Priyawat and Kim Dental Services

  dba Omnia Dental Care

  • Oral and Maxillofacial Surgery Clinic/Center
  • Chino Hills, CA
  • NPI 1801461561
  Medicare reassignment NPD
• Priyawat Dental Group Inc

  • Dentist
  • Chino Hills, CA
  • NPI 1689513483
  NPD Authorized official
• Rupporn Priyawat DDS Inc

  • Dentist
  • Irvine, CA
  • NPI 1780553222
  NPD Authorized official
• Ho Jung Kim DDS Inc

  dba M Dental Group

  • Dentist
  • Fullerton, CA
  • NPI 1023415684
  NPD
• Lopez and Stromberg Dental Corporation

  dba Parkway Dental Group

  • General Practice Dentistry
  • Apple Valley, CA
  • NPI 1265610802
  NPD (past)

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1033453667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 DESERT BLOOM",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926188872",
            "telephone_number": "951-999-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15911 POMONA RINCON RD STE 120",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095567",
            "telephone_number": "909-497-9449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIYAWAT",
        "first_name": "RUPPORN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-20",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61647",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "61647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Prieto
• Geraldine Vanessa Prieto
• Prime RX Chino Hills Inc (Chino Hills Pharmacy)
• Priyawat and Kim Dental Services (Omnia Dental Care)
• Priyawat Dental Group Inc
• Pro-Body Orthopaedic & Sports Physical Therapy, Inc. (Pro-Body Physical Therapy)
• Prototypes
• Geoffrey Putnam, MA BCBA
• Taylor Shannon Quaranta
• Quinn Yu DDS Corp

• Oral and Maxillofacial Surgery (Dentist) in Chino Hills, CA
• Providers in Chino Hills, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.