Active NPI
Ivanna Nykolaychuck
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1154447258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 48346
- Practice address
- 514 E Washington Blvd
Los Angeles, CA 90015-3723 - Phone
- (323) 851-2423
- NPI assigned
- Mar 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 48346 | CA | Primary |
Addresses
Primary practice location
514 E Washington Blvd
Los Angeles, CA 90015-3723
Mailing address
7244 Hillside Ave
Apt. #403
Los Angeles, CA 90046-2353
Phone (323) 851-2423
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 |
|---|---|---|---|
| 48346 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154447258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7244 HILLSIDE AVE",
"address_2": "APT. #403",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900462353",
"telephone_number": "323-851-2423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 E WASHINGTON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900153723",
"telephone_number": "323-851-2423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYKOLAYCHUCK",
"first_name": "IVANNA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "48346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.