Individual provider Active NPI

Gamal Tayab, D.D.S.

  • General Practice Dentistry
  • San Gabriel, CA
National Provider Identifier
1174668297
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
31987 Issued in CA
Practice address
702 S del Mar Ave Ste a
San Gabriel, CA 91776-2440
Phone
(626) 287-9781
Fax
(626) 287-4208
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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 31987 CA Primary

Addresses

Primary practice location

702 S del Mar Ave Ste a
San Gabriel, CA 91776-2440

Mailing address

702 S del Mar Ave Ste a
San Gabriel, CA 91776-2440
Phone (626) 287-9781

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
I20160425002526 CA Order and Referring Only - DentistPractitioner - Dentist 2365741337

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31987CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Del Mar Family Dental General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1174668297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S DEL MAR AVE STE A",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917762440",
            "telephone_number": "626-287-9781",
            "fax_number": "626-287-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S DEL MAR AVE STE A",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917762440",
            "telephone_number": "626-287-9781",
            "fax_number": "626-287-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYAB",
        "first_name": "GAMAL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "31987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

Verify at the official NPI Registry.