Dutran Tyler DO, MD, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

C139636 Issued in CA

Practice address

12401 Wilshire Blvd Ste 104
Los Angeles, CA 90025-1015

Phone

(203) 200-7280

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678

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.

• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty practice Group

  • Orthopaedic Surgery Physician
  • Elmhurst, NY
  • NPI 1609120674
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Anesthesiology Physician
  • Elmhurst, NY
  • NPI 1063766038
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Surgery Physician
  • Elmhurst, NY
  • NPI 1073867040
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Internal Medicine Physician
  • Elmhurst, NY
  • NPI 1184977324
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Cardiovascular Disease Physician
  • Elmhurst, NY
  • NPI 1417201484
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Pediatrics Physician
  • Elmhurst, NY
  • NPI 1518211580
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Obstetrics & Gynecology Physician
  • Elmhurst, NY
  • NPI 1578817540
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Nephrology Physician
  • Elmhurst, NY
  • NPI 1780938753
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Geriatric Medicine (Internal Medicine) Physician
  • Elmhurst, NY
  • NPI 1871847848
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Pulmonary Disease Physician
  • Elmhurst, NY
  • NPI 1962756932
  NPD
• Icahn School of Medicine at Mount Sinai

  dba Mount Sinai Elmhurst Faculty Practice Group

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Elmhurst, NY
  • NPI 1972857944
  NPD
• Aesthetic & Maxillofacial Surgery Center of Darien PC

  • Ambulatory Surgical Clinic/Center
  • Darien, CT
  • NPI 1821207994
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645920000000",
    "number": "1053490961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12401 WILSHIRE BLVD STE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251015",
            "telephone_number": "203-200-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12401 WILSHIRE BLVD STE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251015",
            "telephone_number": "203-200-7280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6505 Rosemead Blvd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Pico Rivera",
            "state": "CA",
            "postal_code": "906603543",
            "country_code": "US",
            "telephone_number": "562-942-1062",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7901 Broadway",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "NY",
            "postal_code": "113731329",
            "country_code": "US",
            "telephone_number": "718-334-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DO",
        "first_name": "DUTRAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "MD, DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2022-02-27",
        "certification_date": "2022-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "052760",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64626",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CT",
            "license": "049194",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NY",
            "license": "257471",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "C139636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cam V DO, DDS
• Caroline DO
• Catherine Thanh Thao DO
• Duc H DO, M.D.
• Dung Thi My DO, MD
• Helen Hae Sun DO
• Huong DO
• Jenny Loc DO, RN, BSN
• John DO, MD
• Josephine DO

• Oral & Maxillofacial Surgery (D.M.D.) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2022; 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.