Individual provider Active NPI

Severino Bartolome Palaganas Jr., DDS

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1063559573
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
53261 Issued in CA
Practice address
2023 Beverly Blvd
Los Angeles, CA 90057-2417
Phone
(213) 353-9931
NPI assigned
Jan 31, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 53261 CA Primary

Addresses

Primary practice location

2023 Beverly Blvd
Los Angeles, CA 90057-2417

Mailing address

4341 Eagle Rock Blvd Apt 3
Los Angeles, CA 90041-3243
Phone (323) 717-9063

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251021001528 CA Practitioner - Dentist 5991842726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

808 W 58TH St
Los Angeles, CA 90037-3632

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53261CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
St. Johns Community Health CurrentSince Aug 7, 2025 Accepting new patients
St. Johns Community Health CurrentSince Aug 7, 2025 Accepting new patients
St. Johns Community Health Current Accepting new patients
St. Johns Community Health Past Accepting new patients

Locations

2115 N Wilmington Ave
Compton, CA 90222
Phone (310) 603-1332

1821 S San Jacinto Ave
Ste D
San Jacinto, CA 92583
Phone 32328598302332

1500 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 381-1591

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063559573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4341 EAGLE ROCK BLVD APT 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900413243",
            "telephone_number": "323-717-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572417",
            "telephone_number": "213-353-9931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALAGANAS",
        "first_name": "SEVERINO",
        "middle_name": "BARTOLOME",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.