Active NPI
Robert K Mondavi, DDS
- Dentist
- Torrance, CA
National Provider Identifier
1134386097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 42169
- Practice address
- 17311 Yukon Ave
Torrance, CA 90504 - Phone
- (310) 324-3333
- Fax
- (310) 324-3666
- NPI assigned
- May 19, 2008
- Last updated
- May 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 42169 | CA | Primary |
| General Practice Dentistry | 1223G0001X | 42169 | CA |
Addresses
Primary practice location
17311 Yukon Ave
Torrance, CA 90504
Mailing address
17311 Yukon Ave
Torrance, CA 90504
Phone (310) 324-3333
Other names 1
- Robert Mondavi
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
| License | State | Type | Specialty |
|---|---|---|---|
| 42169 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1134386097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17311 YUKON AVE",
"city": "TORRANCE",
"state": "CA",
"postal_code": "90504",
"telephone_number": "310-324-3333",
"fax_number": "310-324-3666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17311 YUKON AVE",
"city": "TORRANCE",
"state": "CA",
"postal_code": "90504",
"telephone_number": "310-324-3333",
"fax_number": "310-324-3666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONDAVI",
"first_name": "ROBERT",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "42169",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "42169",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ROBERT",
"last_name": "MONDAVI",
"credential": "DDS",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.