Active NPI
Eileen Welch, DDS
- Dentist
- Studio City, CA
National Provider Identifier
1144617796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 64806
- Practice address
- 12930 Ventura Blvd Ste 226
Studio City, CA 91604-2200 - Phone
- (818) 465-7545
- NPI assigned
- Apr 22, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 64806 | CA | Primary |
Addresses
Primary practice location
12930 Ventura Blvd Ste 226
Studio City, CA 91604-2200
Mailing address
11819 Wolf Creek LN
Plainfield, IL 60585-2607
Other practice location 1
483 N Aviation Blvd Bldg 210
El Segundo, CA 90245-2808
Phone (630) 254-0898
Other practice location 2
11819 Wolf Creek Ln
Plainfield, IL 60585-2607
Phone (630) 254-0898
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 |
|---|---|---|---|---|
| I20230321002559 | CA | Order and Referring Only - Dentist | 4183098726 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64806 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1144617796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11819 WOLF CREEK LN",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605852607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12930 VENTURA BLVD STE 226",
"city": "STUDIO CITY",
"state": "CA",
"postal_code": "916042200",
"telephone_number": "818-465-7545"
}
],
"practiceLocations": [
{
"address_1": "483 N Aviation Blvd Bldg 210",
"address_purpose": "LOCATION",
"city": "El Segundo",
"state": "CA",
"postal_code": "902452808",
"country_code": "US",
"telephone_number": "630-254-0898",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11819 Wolf Creek Ln",
"address_purpose": "LOCATION",
"city": "Plainfield",
"state": "IL",
"postal_code": "605852607",
"country_code": "US",
"telephone_number": "630-254-0898",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WELCH",
"first_name": "EILEEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-22",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "64806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Studio City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.