Active NPI
George Ji Jun Tao, DDS
- Dentist
- Alta Loma, CA
National Provider Identifier
1194867788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 42703
- Practice address
- 6626 Carnelian St
Alta Loma, CA 91701 - Phone
- (909) 987-4113
- Fax
- (909) 987-3673
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 42703 | CA | Primary |
Addresses
Primary practice location
6626 Carnelian St
Alta Loma, CA 91701
Mailing address
9588 Baseline Rd. Ste 100
Rancho Cucamonga, CA 91701-6439
Phone (909) 987-4113
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 |
|---|---|---|---|---|
| I20150515002228 | CA | Order and Referring Only - Oral Surgery | 3173843083 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42703 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630972800000",
"number": "1194867788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9588 BASELINE RD. STE 100",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917016439",
"telephone_number": "909-987-4113",
"fax_number": "909-987-3678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6626 CARNELIAN ST",
"city": "ALTA LOMA",
"state": "CA",
"postal_code": "91701",
"telephone_number": "909-987-4113",
"fax_number": "909-987-3673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAO",
"first_name": "GEORGE",
"middle_name": "JI JUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2021-09-07",
"certification_date": "2021-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "42703",
"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 Sep 7, 2021; 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.