Individual provider Active NPI

Natalia Maria Homyak, DDS

  • General Practice Dentistry
  • Marina del Rey, CA
National Provider Identifier
1154410710
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
49542 Issued in CA
Practice address
13160 Mindanao Way
Room 170
Marina del Rey, CA 90292-6393
Phone
(310) 823-6400
Fax
(310) 823-8600
NPI assigned
Oct 12, 2006
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 49542 CA Primary

Addresses

Primary practice location

13160 Mindanao Way
Room 170
Marina del Rey, CA 90292-6393

Mailing address

3200 Barbydell Drive
Los Angeles, CA 90064-4808
Phone (714) 865-9407

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160114003017 CA Order and Referring Only - DentistPractitioner - Dentist 1153624721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
49542CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1154410710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BARBYDELL DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644808",
            "telephone_number": "714-865-9407",
            "fax_number": "310-823-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13160 MINDANAO WAY",
            "address_2": "ROOM 170",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926393",
            "telephone_number": "310-823-6400",
            "fax_number": "310-823-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMYAK",
        "first_name": "NATALIA",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.