Active NPI
Khal Liam Mancini, D.D.S
- Dentist
- Rancho Cucamonga, CA
National Provider Identifier
1104599612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 106718
- Practice address
- 9543 Retreat PL
Rancho Cucamonga, CA 91730-9201 - Phone
- (323) 649-4629
- NPI assigned
- Jul 29, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 106718 | CA | Primary |
Addresses
Primary practice location
9543 Retreat PL
Rancho Cucamonga, CA 91730-9201
Mailing address
9543 Retreat PL
Rancho Cucamonga, CA 91730-9201
Phone (323) 649-4629
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 |
|---|---|---|---|
| 106718 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1104599612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9543 RETREAT PL",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917309201",
"telephone_number": "323-649-4629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9543 RETREAT PL",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917309201",
"telephone_number": "323-649-4629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANCINI",
"first_name": "KHAL",
"middle_name": "LIAM",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-29",
"last_updated": "2021-07-29",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "106718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.