Active NPI
Pamela D Ichiyasu, R. D. H.
- Dental Hygienist
- Denver, CO
National Provider Identifier
1104246875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 906146
- Practice address
- 5031 S Ulster St
Suite 100
Denver, CO 80237-2804 - Phone
- (303) 779-8587
- Fax
- (303) 779-9182
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 906146 | CO | Primary |
Addresses
Primary practice location
5031 S Ulster St
Suite 100
Denver, CO 80237-2804
Mailing address
1511 Beacon Hill Dr
Highlands Ranch, CO 80126-4268
Phone (303) 378-4977
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 |
|---|---|---|---|
| 906146 | CO | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colorado Dhca , DTC, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Denver, CO
- NPI 1023153673
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398124800000",
"number": "1104246875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1511 BEACON HILL DR",
"city": "HIGHLANDS RANCH",
"state": "CO",
"postal_code": "801264268",
"telephone_number": "303-378-4977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5031 S ULSTER ST",
"address_2": "SUITE 100",
"city": "DENVER",
"state": "CO",
"postal_code": "802372804",
"telephone_number": "303-779-8587",
"fax_number": "303-779-9182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHIYASU",
"first_name": "PAMELA",
"middle_name": "D",
"credential": "R. D. H.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-22",
"last_updated": "2014-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CO",
"license": "906146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.