Individual provider Active NPI

Glenn G Lew, D.M.D.

  • General Practice Dentistry
  • Redwood City, CA
National Provider Identifier
1073797205
Registry record updated Dec 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
35 Renato CT
Suite a
Redwood City, CA 94061-4095
Phone
(650) 369-0366
Fax
(650) 369-0377
NPI assigned
Dec 24, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 24, 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 CA Primary

Addresses

Primary practice location

35 Renato CT
Suite a
Redwood City, CA 94061-4095

Mailing address

35 Renato CT
Suite a
Redwood City, CA 94061-4095
Phone (650) 369-0366

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

LicenseStateTypeSpecialty
942922785CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198454400000",
    "number": "1073797205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 RENATO CT",
            "address_2": "SUITE A",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940614095",
            "telephone_number": "650-369-0366",
            "fax_number": "650-369-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 RENATO CT",
            "address_2": "SUITE A",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940614095",
            "telephone_number": "650-369-0366",
            "fax_number": "650-369-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEW",
        "first_name": "GLENN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.