Active NPI
Ignacio Esaul Mendoza Ham, D.D.S
- General Practice Dentistry
- Modesto, CA
National Provider Identifier
1215583570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 103488
- Practice address
- 3025 McHenry Ave
Ste N
Modesto, CA 95350-9535 - Phone
- (209) 527-3990
- NPI assigned
- Aug 13, 2019
- Last updated
- Jul 15, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 103488 | CA | Primary |
Addresses
Primary practice location
3025 McHenry Ave
Ste N
Modesto, CA 95350-9535
Mailing address
3025 McHenry Ave Ste N
Modesto, CA 95350-1449
Phone (209) 527-3990
Other practice location 1
706 Main St
Livingston, CA 95334-1308
Phone (209) 535-9933
Other practice location 2
3309 Sierra St
Riverbank, CA 95367-2440
Phone (209) 872-3399
Other practice location 3
333 San Carlos Way Ste A
Stockton, CA 95207-2037
Phone (209) 536-8333
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 |
|---|---|---|---|
| 103488 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626307200000",
"number": "1215583570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3025 MCHENRY AVE STE N",
"city": "MODESTO",
"state": "CA",
"postal_code": "953501449",
"telephone_number": "209-527-3990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3025 MCHENRY AVE",
"address_2": "STE N",
"city": "MODESTO",
"state": "CA",
"postal_code": "953509535",
"telephone_number": "209-527-3990"
}
],
"practiceLocations": [
{
"address_1": "706 Main St",
"address_purpose": "LOCATION",
"city": "Livingston",
"state": "CA",
"postal_code": "953341308",
"country_code": "US",
"telephone_number": "209-535-9933",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3309 Sierra St",
"address_purpose": "LOCATION",
"city": "Riverbank",
"state": "CA",
"postal_code": "953672440",
"country_code": "US",
"telephone_number": "209-872-3399",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "333 San Carlos Way Ste A",
"address_purpose": "LOCATION",
"city": "Stockton",
"state": "CA",
"postal_code": "952072037",
"country_code": "US",
"telephone_number": "209-536-8333",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MENDOZA HAM",
"first_name": "IGNACIO",
"middle_name": "ESAUL",
"name_prefix": "Mr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-13",
"last_updated": "2021-07-15",
"certification_date": "2021-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "103488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.