Active NPI
Milan Manoj Irvin, D.M.D.
- Dentist
- Alta Loma, CA
National Provider Identifier
1174871966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61782
- Practice address
- 9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827 - Phone
- (510) 387-5812
- NPI assigned
- Aug 27, 2012
- Last updated
- Aug 27, 2012
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 61782 | CA | Primary |
Addresses
Primary practice location
9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827
Mailing address
9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827
Phone (510) 387-5812
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61782 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1174871966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9330 BASELINE RD",
"address_2": "STE 108",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "917015827",
"telephone_number": "510-387-5812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9330 BASELINE RD",
"address_2": "STE 108",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "917015827",
"telephone_number": "510-387-5812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVIN",
"first_name": "MILAN",
"middle_name": "MANOJ",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-27",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alta Loma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.