Individual provider Active NPI

Diane L Haun, RDHAP

  • Dental Hygienist
  • Culver City, CA
National Provider Identifier
1093860876
Registry record updated May 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
HAP 38 Issued in CA
Practice address
10736 Jefferson Blvd # 411
Culver City, CA 90230-4933
Phone
(310) 617-2302
Fax
(310) 572-6062
NPI assigned
Jan 24, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X HAP 38 CA Primary
Dental Hygienist 124Q00000X 11303 CA

Addresses

Primary practice location

10736 Jefferson Blvd # 411
Culver City, CA 90230-4933

Mailing address

10736 Jefferson Blvd # 411
Culver City, CA 90230-4933
Phone (310) 617-2302

Other identifiers 3

IdentifierTypeStateIssuer
11303OtherCADELTA DENTAL
H00038-01MedicaidCA
147044OtherDELTA DENTAL OF CALIFORNI

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
11303CAMDClinical Social Worker
HAP 38CAMDDental Hygienist

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243468800000",
    "number": "1093860876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10736 JEFFERSON BLVD # 411",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304933",
            "telephone_number": "310-617-2302",
            "fax_number": "310-572-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10736 JEFFERSON BLVD # 411",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304933",
            "telephone_number": "310-617-2302",
            "fax_number": "310-572-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUN",
        "first_name": "DIANE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "RDHAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2009-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "HAP 38",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "11303",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "11303",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H00038-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF CALIFORNI",
            "identifier": "147044",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; 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.