Active NPI
Peter Y Umekubo Jr., D.D.S.
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1194022400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 23955
- Practice address
- 548 19TH St
San Diego, CA 92102-2804 - Phone
- (619) 233-6000
- Fax
- (619) 233-6578
- NPI assigned
- Feb 23, 2011
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 23955 | CA | Primary |
Addresses
Primary practice location
548 19TH St
San Diego, CA 92102-2804
Mailing address
548 19TH St
San Diego, CA 92102-2804
Phone (619) 233-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23955 | Other | CA | CALIFORNIA STATE DENTAL LICENSE NUMBER |
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": "1298419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298419200000",
"number": "1194022400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "548 19TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921022804",
"telephone_number": "619-233-6000",
"fax_number": "619-233-6578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "548 19TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921022804",
"telephone_number": "619-233-6000",
"fax_number": "619-233-6578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UMEKUBO",
"first_name": "PETER",
"middle_name": "Y",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-23",
"last_updated": "2011-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "23955",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE DENTAL LICENSE NUMBER",
"identifier": "23955",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.