Active NPI
Matthew Brown
- Dentist
- Inglewood, CA
National Provider Identifier
1215520671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 105780
- Practice address
- 808 E Manchester Blvd
Inglewood, CA 90301-1914 - Phone
- (310) 671-1234
- NPI assigned
- Feb 17, 2021
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 105780 | CA | Primary |
Addresses
Primary practice location
808 E Manchester Blvd
Inglewood, CA 90301-1914
Mailing address
808 E Manchester Blvd
Inglewood, CA 90301-1914
Other practice location 1
Dr smile 2104 CA-1 #5, Lomita, CA 90717
Lomita, CA 90717
Phone (323) 590-0457
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 |
|---|---|---|---|
| 105780 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1215520671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 E MANCHESTER BLVD",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "808 E MANCHESTER BLVD",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011914",
"telephone_number": "310-671-1234"
}
],
"practiceLocations": [
{
"address_1": "Dr smile 2104 CA-1 #5, Lomita, CA 90717",
"address_purpose": "LOCATION",
"city": "Lomita",
"state": "CA",
"postal_code": "90717",
"country_code": "US",
"telephone_number": "323-590-0457",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROWN",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-17",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "105780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.