Lydia Koernianingsih, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

48488 Issued in CA

Practice address

1125 E 17TH St Ste W234
Santa Ana, CA 92701-2228

Phone

(714) 558-4895

Fax

(714) 558-4896

NPI assigned

Jun 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Lydia Koernianingsih DDS a Prof Corp

  • Dentist
  • Santa Ana, CA
  • NPI 1922349521
  NPD Authorized official

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1083817423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E 17TH ST STE W234",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012228",
            "telephone_number": "714-558-4895",
            "fax_number": "714-558-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E 17TH ST STE W234",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012228",
            "telephone_number": "714-558-4895",
            "fax_number": "714-558-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOERNIANINGSIH",
        "first_name": "LYDIA",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "48488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailyn Kocher
• Susan Akemi Kodaira, P.T.
• Kodiak HME LLC
• Michelle Koehler
• Karl Koerner, SLP
• Diana Kogan, LMFT
• Koh Dental Corporation
• Jane Koh, N.P.
• Philip D Koh, D.D.S
• Nathan Kok, RN

• Dentist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.