Active NPI
Rylan Gustafson
- Endodontics
- Chico, CA
National Provider Identifier
1245226752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 57593
- Practice address
- 101 Raley Blvd
Suite 202
Chico, CA 95928-8352 - Phone
- (530) 592-4688
- NPI assigned
- Sep 21, 2005
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 57593 | CA | Primary |
Addresses
Primary practice location
101 Raley Blvd
Suite 202
Chico, CA 95928-8352
Mailing address
101 Raley Blvd
Ste 202
Chico, CA 95928-8352
Phone (530) 592-4688
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 |
|---|---|---|---|
| 57593 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1245226752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 RALEY BLVD",
"address_2": "STE 202",
"city": "CHICO",
"state": "CA",
"postal_code": "959288352",
"telephone_number": "530-592-4688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 RALEY BLVD",
"address_2": "SUITE 202",
"city": "CHICO",
"state": "CA",
"postal_code": "959288352",
"telephone_number": "530-592-4688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "RYLAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-21",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "57593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.