Individual provider Active NPI

Dexter Canoy

  • Otorhinolaryngology & Head-Neck Registered Nurse
  • Los Angeles, CA
National Provider Identifier
1104789809
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otorhinolaryngology & Head-Neck Registered NurseTaxonomy code 163WX0601X
License
95292177 Issued in CA
Practice address
11301 Wilshire Blvd
Los Angeles, CA 90073-1003
Phone
(310) 478-3711
NPI assigned
Dec 9, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Continuing Education/Staff Development Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1600X 95292177 CA
Medical-Surgical Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WM0705X 95292177 CA
Otorhinolaryngology & Head-Neck Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WX0601X 95292177 CA Primary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 95292177 CA

Addresses

Primary practice location

11301 Wilshire Blvd
Los Angeles, CA 90073-1003

Mailing address

1636 Cherry Tree PL
Upland, CA 91784-2530
Phone (626) 510-3301

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
95292177CAMDContinuing Education/Staff Development Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1765238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1104789809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 CHERRY TREE PL",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917842530",
            "telephone_number": "626-510-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANOY",
        "first_name": "DEXTER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-12-09",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "CA",
            "license": "95292177",
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "CA",
            "license": "95292177",
            "primary": false
        },
        {
            "code": "163WX0601X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Otorhinolaryngology & Head-Neck",
            "state": "CA",
            "license": "95292177",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95292177",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.