NPIMap

Organization Active NPI

UCLA Venice Dental Center

  • Dental Clinic/Center
  • Venice, CA
National Provider Identifier
1255465902
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
UCLA VENICE DENTAL CENTER
Practice address
323 Lincoln Blvd
Venice, CA 90291-2842
Phone
(310) 392-4103
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Authorized official

Name
Dr. Marc Hayaseti, DDS
Title
Associate Clinical Professor
Phone
(310) 825-4855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X CA Primary

Addresses

Primary practice location

323 Lincoln Blvd
Venice, CA 90291-2842

Mailing address

10833 Le Conte Ave
CHS 33-019
Los Angeles, CA 90095-1668
Phone (310) 825-4855

Other identifiers 1

IdentifierTypeStateIssuer
G01004-01OtherCADENTI-CAL

Other names 1

  • UCLA School of Dentistry Other name

National Provider Directory

National Provider Directory
Tax ID family
Regents of the Univ of Ca56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Locations

10833 Le Conte Ave
#33019
Los Angeles, CA 90095

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1255465902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "CHS 33-019",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951668",
            "telephone_number": "310-825-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912842",
            "telephone_number": "310-392-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCLA VENICE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "HAYASETI",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "ASSOCIATE CLINICAL PROFESSOR",
        "authorized_official_telephone_number": "310-825-4855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "G01004-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCLA School of Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Venice, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; 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.