Individual provider Active NPI

Christine Min, DDS

  • Pediatric Dentistry
  • Riverside, CA
National Provider Identifier
1235113283
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
61151 Issued in CA
Practice address
5225 Canyon Crest Dr
#309
Riverside, CA 92507-6301
Phone
(712) 574-3307
NPI assigned
Dec 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8177 IA
Pediatric Dentistry 1223P0221X 24782 NJ
Pediatric Dentistry 1223P0221X 54316-1 NY
Pediatric Dentistry 1223P0221X 61151 CA Primary

Addresses

Primary practice location

5225 Canyon Crest Dr
#309
Riverside, CA 92507-6301

Mailing address

5225 Canyon Crest Dr
#309
Riverside, CA 92507-6301
Phone (712) 574-3307

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161018001921 CA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 0143518522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8177IAMDDentist
54316-1NYMDPediatric Dentist
61151CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Dentistry of Rancho Cucamonga Pediatric Dentistry Current Accepting new patients
My Dentist and Me Pediatric Dentistry Pediatric Dentistry Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398211200000",
    "number": "1235113283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 CANYON CREST DR",
            "address_2": "#309",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925076301",
            "telephone_number": "712-574-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 CANYON CREST DR",
            "address_2": "#309",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925076301",
            "telephone_number": "712-574-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIN",
        "first_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "8177",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "24782",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "54316-1",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "61151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.