Jose Carlos Daudt Polido, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

39870 Issued in CA

Practice address

4650 W Sunset Blvd
Ms# 116
Los Angeles, CA 90027-6062

Phone

(323) 361-2130

Fax

(323) 361-1090

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Children'S Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653
  Medicare reassignment NPD
• Childrens Hospital Medical Practice Corporation

  • Pediatrics Physician
  • New Orleans, LA
  • NPI 1821090713
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363564800000",
    "number": "1104912377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6430 W SUNSET BLVD",
            "address_2": "SUITE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287901",
            "telephone_number": "323-361-4116",
            "fax_number": "323-361-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "address_2": "MS# 116",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2130",
            "fax_number": "323-361-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLIDO",
        "first_name": "JOSE",
        "middle_name": "CARLOS DAUDT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "39870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D39870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muriel Yarnick Poli, DC
• Gabriel Poliboy, M.D.
• Melissa Poliboy, M.D.
• Laura Policarpo Hernandez, MSW, ACSW
• Polido Professional Dental Corporation
• Kristel Rei M Polintan
• Nicole Poliquin, M.D.
• Seth Politano, D.O.
• Delores Genise Polite
• Dorothy M. Polite

• Pediatric Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; 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.

Verify at the official NPI Registry.