Active NPI
Omar Hisham Baker Sudqi, B.D.S.
- Dentist
- Lancaster, CA
National Provider Identifier
1083732010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 46141
- Practice address
- 45104 10 TH St W
Antelope Valley Community Clinic
Lancaster, CA 93534-2310 - Phone
- (661) 942-2391
- Fax
- (661) 902-6839
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- 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 | 46141 | CA | Primary |
Addresses
Primary practice location
45104 10 TH St W
Antelope Valley Community Clinic
Lancaster, CA 93534-2310
Mailing address
45104 10TH St W
Lancaster, CA 93534-2310
Phone (661) 942-2391
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 |
|---|---|---|---|
| 46141 | CA | MD | Private Vehicle |
Interoperability endpoints
- osudqi@direct.westerndental.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484179200000",
"number": "1083732010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45104 10TH ST W",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935342310",
"telephone_number": "661-942-2391",
"fax_number": "661-902-6839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45104 10 TH ST W",
"address_2": "ANTELOPE VALLEY COMMUNITY CLINIC",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935342310",
"telephone_number": "661-942-2391",
"fax_number": "661-902-6839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDQI",
"first_name": "OMAR",
"middle_name": "HISHAM BAKER",
"credential": "B.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2017-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "46141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.