NPIMap

Organization Active NPI

Susie T Chan DDS a Professional Dental Corportation

Doing business as smile.

  • Dental Clinic/Center
  • San Diego, CA
National Provider Identifier
1134473408
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
57743 Issued in CA
Legal business name
SUSIE T CHAN DDS A PROFESSIONAL DENTAL CORPORTATION
Doing business as
smile.
Practice address
16918 Dove Canyon Rd
Ste 201
San Diego, CA 92127-3501
Phone
(858) 924-1000
NPI assigned
Nov 7, 2012
Last updated
Nov 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

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

Authorized official

Name
Dr. Susie T Ro, DDSNPI 1134495096
Title
Dentist
Phone
(714) 421-0430

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 57743 CA Primary

Addresses

Primary practice location

16918 Dove Canyon Rd
Ste 201
San Diego, CA 92127-3501

Mailing address

16918 Dove Canyon Rd
Ste 201
San Diego, CA 92127-3501
Phone (858) 924-1000

Other names 1

  • smile. Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1134473408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16918 DOVE CANYON RD",
            "address_2": "STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921273501",
            "telephone_number": "858-924-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16918 DOVE CANYON RD",
            "address_2": "STE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921273501",
            "telephone_number": "858-924-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSIE T CHAN DDS A PROFESSIONAL DENTAL CORPORTATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-07",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "RO",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "714-421-0430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "57743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "smile.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; 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.