Active NPI
Andrea Lynne Henderson, D.D.S, F.A.C.P
- Prosthodontics
- Los Angeles, CA
National Provider Identifier
1194072231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 61553
- Practice address
- 11980 San Vicente Blvd
Suite 918
Los Angeles, CA 90049-5012 - Phone
- (310) 826-6535
- NPI assigned
- Aug 8, 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 61553 | CA | Primary |
Addresses
Primary practice location
11980 San Vicente Blvd
Suite 918
Los Angeles, CA 90049-5012
Mailing address
11980 San Vicente Blvd
Ste 918
Los Angeles, CA 90049-5012
Phone (310) 826-6535
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61553 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1194072231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD",
"address_2": "STE 918",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495012",
"telephone_number": "310-826-6535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD",
"address_2": "SUITE 918",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495012",
"telephone_number": "310-826-6535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "ANDREA",
"middle_name": "LYNNE",
"name_prefix": "Dr.",
"credential": "D.D.S, F.A.C.P",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-08",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "61553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.