Active NPI
K. Moldenhauer, D.D.S.
- Periodontics
- Pasadena, CA
National Provider Identifier
1083985741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 36266
- Practice address
- 175 S El Molino Ave
Suite #7
Pasadena, CA 91101-2564 - Phone
- (626) 793-1881
- NPI assigned
- Jan 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 36266 | CA | Primary |
Addresses
Primary practice location
175 S El Molino Ave
Suite #7
Pasadena, CA 91101-2564
Mailing address
175 S El Molino Ave
Suite #7
Pasadena, CA 91101-2564
Phone (626) 793-1881
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160317001191 | CA | Order and Referring Only - Dentist | 8820394802 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36266 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327449600000",
"number": "1083985741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 S EL MOLINO AVE",
"address_2": "SUITE #7",
"city": "PASADENA",
"state": "CA",
"postal_code": "911012564",
"telephone_number": "626-793-1881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 S EL MOLINO AVE",
"address_2": "SUITE #7",
"city": "PASADENA",
"state": "CA",
"postal_code": "911012564",
"telephone_number": "626-793-1881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLDENHAUER",
"first_name": "K.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-25",
"last_updated": "2012-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "36266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.