NPIMap

Organization Active NPI

Ray Derakshan, DMD Inc

  • Preferred Provider Organization
  • San Diego, CA
National Provider Identifier
1255579793
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
46044 Issued in CA
Legal business name
RAY DERAKSHAN, DMD INC
Practice address
11134 Rancho Carmel Dr. #103
San Diego, CA 92128
Phone
(858) 485-1010
Fax
(858) 485-1116
NPI assigned
Jan 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Authorized official

Name
Dr. Ray Derakshan, DMD INC.NPI 1770621591
Title
Dentist
Phone
(858) 485-1010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 46044 CA Primary

Addresses

Primary practice location

11134 Rancho Carmel Dr. #103
San Diego, CA 92128

Mailing address

11134 Rancho Carmel Dr. #103
San Diego, CA 92128
Phone (858) 485-1010

National Provider Directory

National Provider Directory

Locations

11134 Rancho Carmel Dr
Ste 103
San Diego, CA 92128
Phone (858) 485-1010

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1232496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1255579793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11134 RANCHO CARMEL DR. #103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92128",
            "telephone_number": "858-485-1010",
            "fax_number": "858-485-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11134 RANCHO CARMEL DR. #103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92128",
            "telephone_number": "858-485-1010",
            "fax_number": "858-485-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAY DERAKSHAN, DMD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-21",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "DERAKSHAN",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "858-485-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD INC."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "46044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.

Verify at the official NPI Registry.