Individual provider Active NPI

Brent Takashi Honda, DDS

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1124568175
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS103380 Issued in CA
Practice address
2829 S Grand Ave
Los Angeles, CA 90007-3304
Phone
(213) 669-7000
NPI assigned
Feb 23, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X DDS103380 CA Primary

Addresses

Primary practice location

2829 S Grand Ave
Los Angeles, CA 90007-3304

Mailing address

1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029
Phone (808) 741-9913

Other practice location 1

1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029
Phone (808) 741-9913

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
DDS103380CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1124568175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "address_2": "CLINIC TOWER, SUITE A7D",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331029",
            "telephone_number": "808-741-9913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 S GRAND AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900073304",
            "telephone_number": "213-669-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N State St",
            "address_2": "Clinic Tower, Suite A7D",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900331029",
            "country_code": "US",
            "telephone_number": "808-741-9913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HONDA",
        "first_name": "BRENT",
        "middle_name": "TAKASHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-23",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS103380",
            "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 Jun 8, 2020; 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.