Active NPI
Sean Sunyoto, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1124514112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 102689
- Practice address
- 936 Crenshaw Blvd Ste 101
Los Angeles, CA 90019-1948 - Phone
- (323) 934-2804
- NPI assigned
- Jul 3, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 102689 | CA | Primary |
Addresses
Primary practice location
936 Crenshaw Blvd Ste 101
Los Angeles, CA 90019-1948
Mailing address
17840 Powell PL
Artesia, CA 90701-3879
Phone (626) 510-2606
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190715000865 | CA | Practitioner - Oral Surgery | 0749515674 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530576000000",
"number": "1124514112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17840 POWELL PL",
"city": "ARTESIA",
"state": "CA",
"postal_code": "907013879",
"telephone_number": "626-510-2606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "936 CRENSHAW BLVD STE 101",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900191948",
"telephone_number": "323-934-2804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNYOTO",
"first_name": "SEAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-03",
"last_updated": "2018-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "102689",
"primary": true
}
],
"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 Jul 3, 2018; 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.