Active NPI
Mandi Lynn Wilson, D.D.S.
- Dentist
- Whittier, CA
National Provider Identifier
1063821429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63484
- Practice address
- 13203 Hadley St Ste 105
Whittier, CA 90601-4530 - Phone
- (562) 696-6555
- NPI assigned
- Aug 10, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 63484 | CA | Primary |
Addresses
Primary practice location
13203 Hadley St Ste 105
Whittier, CA 90601-4530
Mailing address
13203 Hadley St Ste 105
Whittier, CA 90601-4530
Phone (562) 696-6555
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 |
|---|---|---|---|
| 63484 | CA | MD | Pharmacist |
Interoperability endpoints
- mwilson184040@direct.memorialcare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407628800000",
"number": "1063821429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13203 HADLEY ST STE 105",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906014530",
"telephone_number": "562-696-6555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13203 HADLEY ST STE 105",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906014530",
"telephone_number": "562-696-6555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MANDI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-10",
"last_updated": "2014-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whittier, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.