Active NPI
Anthony Jamil Totah
- Dentist
- San Leandro, CA
National Provider Identifier
1124616859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 105928
- Practice address
- 14895 E 14TH St
San Leandro, CA 94578-2922 - Phone
- (510) 877-4161
- NPI assigned
- Jan 7, 2021
- 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 | 105928 | CA | Primary |
Addresses
Primary practice location
14895 E 14TH St
San Leandro, CA 94578-2922
Mailing address
23 Colton CT
Redwood City, CA 94062-4042
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 |
|---|---|---|---|---|
| I20230321002059 | CA | Order and Referring Only - Dentist | 9638543374 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105928 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1124616859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 COLTON CT",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940624042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14895 E 14TH ST",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945782922",
"telephone_number": "510-877-4161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOTAH",
"first_name": "ANTHONY",
"middle_name": "JAMIL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-07",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "105928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.