Active NPI
Koren I T Ikeda, DOCTOR OF DENTAL MED
- General Practice Dentistry
- Staton, CA
National Provider Identifier
1184742744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34347
- Practice address
- 7092 Katella Ave.
Staton, CA 90680-5179 - Phone
- (714) 761-0564
- NPI assigned
- Mar 26, 2007
- Last updated
- Jul 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 34347 | CA | |
| General Practice Dentistry | 1223G0001X | 34347 | CA | Primary |
Addresses
Primary practice location
7092 Katella Ave.
Staton, CA 90680-5179
Mailing address
P.O. Box 284
Stanton, CA 90680-5179
Phone (714) 761-0564
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160819000706 | CA | Order and Referring Only - Other (Non-Physician) | 0446545149 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34347 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1184742744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 284",
"city": "STANTON",
"state": "CA",
"postal_code": "906805179",
"telephone_number": "714-761-0564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7092 KATELLA AVE.",
"city": "STATON",
"state": "CA",
"postal_code": "906805179",
"telephone_number": "714-761-0564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKEDA",
"first_name": "KOREN",
"middle_name": "I T",
"name_prefix": "Dr.",
"credential": "DOCTOR OF DENTAL MED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "34347",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "34347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.