Active NPI
Carolyn Wahby
- General Practice Dentistry
- Lakewood, CA
National Provider Identifier
1194060046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61905
- Practice address
- 5464 South St
Lakewood, CA 90712-1354 - Phone
- (714) 883-0348
- NPI assigned
- Dec 4, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61905 | CA | Primary |
Addresses
Primary practice location
5464 South St
Lakewood, CA 90712-1354
Mailing address
13905 Visions Dr
La Mirada, CA 90638-6563
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161101002682 | CA | Order and Referring Only - Dentist | 4981982527 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- cwahby528557@direct.llu.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360713600000",
"number": "1194060046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13905 VISIONS DR",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906386563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5464 SOUTH ST",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907121354",
"telephone_number": "714-883-0348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHBY",
"first_name": "CAROLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-04",
"last_updated": "2013-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "61905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; 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.