Hatai Jivagunchainan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11301 Issued in OR

Practice address

940 Astor St Ste C
Astoria, OR 97103-4213

Phone

(971) 206-6688

NPI assigned

Aug 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1154934065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N ROOSEVELT DR STE 110",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971384603",
            "telephone_number": "971-704-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 ASTOR ST STE C",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971034213",
            "telephone_number": "971-206-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIVAGUNCHAINAN",
        "first_name": "HATAI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2021-02-03",
        "certification_date": "2021-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace K Jacobson, PSYD
• James Chiropractic Spine and Joint Center LLC
• Joshua Tyler Jennings, MSW
• Jeremiah Shakespear DDS PC
• Lisa Ann Jimenez, PMHNP
• Erika Irene Johnson, CADC-I, CRM-II, CPSS
• Jeanette Johnson, LCSW
• Kevin Bradley Johnson, CRNA
• Lisa Marie Johnson, NP
• Elizabeth Jolley, MS

• General Practice Dentistry in Astoria, OR
• Providers in Astoria, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.

Verify at the official NPI Registry.