Lebrock Shynnel Blystone, RDA

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

83522 Issued in CA

Practice address

4000 La Rica Ave
Ste D
Baldwin Park, CA 91706-3163

Phone

(626) 430-9171

NPI assigned

Nov 18, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cohen Sedgh, Manavi & Pakravan Dental Corporation

  • Dentist
  • Baldwin Park, CA
  • NPI 1356686679
  NPD (past)
• Ryan Sein Chein Lee DDS Inc

  • General Practice Dentistry
  • Baldwin Park, CA
  • NPI 1285858548
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1205232204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LA RICA AVE",
            "address_2": "STE D",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063163",
            "telephone_number": "626-430-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LA RICA AVE",
            "address_2": "STE D",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063163",
            "telephone_number": "626-430-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYSTONE",
        "first_name": "LEBROCK",
        "middle_name": "SHYNNEL",
        "credential": "RDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-18",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "83522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John M. Bigley, MD
• Joyce Mary Bitar, MD
• Sumner L Blanchard, SP
• Ira A. Blitz, MD
• Gary L. Bluestone, DO
• Frances Angelica Bono
• Ignacio Borenstein, MD
• Mary Bouras, MD
• Hillary Arnelle Bowden
• Adrienna Boynton, MD

• Dental Assistant in Baldwin Park, CA
• Providers in Baldwin Park, CA by specialty
• Dental Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.