NPIMap

Organization Active NPI

Widodo & Ong DDS, Inc.

  • General Practice Dentistry
  • El Monte, CA
National Provider Identifier
1245570258
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
46152 Issued in CA
Legal business name
WIDODO & ONG DDS, INC.
Practice address
11635 Valley Blvd Ste E
El Monte, CA 91732-3071
Phone
(626) 444-7645
Fax
(626) 444-7628
NPI assigned
Feb 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Authorized official

Name
Dr. Andre Widodo, DDS
Title
Dentist
Phone
(626) 444-7645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 46152 CA Primary

Addresses

Primary practice location

11635 Valley Blvd Ste E
El Monte, CA 91732-3071

Mailing address

11635 Valley Blvd Ste E
El Monte, CA 91732-3071
Phone (626) 444-7645

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362009600000",
    "number": "1245570258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11635 VALLEY BLVD STE E",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917323071",
            "telephone_number": "626-444-7645",
            "fax_number": "626-444-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11635 VALLEY BLVD STE E",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917323071",
            "telephone_number": "626-444-7645",
            "fax_number": "626-444-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIDODO & ONG DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-02-28",
        "status": "A",
        "authorized_official_last_name": "WIDODO",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "626-444-7645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Monte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; 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.