Active NPI
Jerry O. Humeniuk, DMD
- Periodontics
- San Francisco, CA
National Provider Identifier
1174722003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 28332
- Practice address
- 500 Sutter St
Suite 815
San Francisco, CA 94102-1107 - Phone
- (415) 398-3957
- NPI assigned
- Jul 11, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 28332 | CA | Primary |
Addresses
Primary practice location
500 Sutter St
Suite 815
San Francisco, CA 94102-1107
Mailing address
500 Sutter St
Suite 815
San Francisco, CA 94102-1107
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484870400000",
"number": "1174722003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SUTTER ST",
"address_2": "SUITE 815",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941021107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SUTTER ST",
"address_2": "SUITE 815",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941021107",
"telephone_number": "415-398-3957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMENIUK",
"first_name": "JERRY",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-11",
"last_updated": "2017-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "28332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.