Active NPI
Patrick Ting So, D.D.S.
- Pediatric Dentistry
- Antioch, CA
National Provider Identifier
1275761124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 58408
- Practice address
- 2390 Country Hills Dr
Antioch, CA 94509-7437 - Phone
- (925) 757-4220
- NPI assigned
- Jun 30, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 58408 | CA | Primary |
Addresses
Primary practice location
2390 Country Hills Dr
Antioch, CA 94509-7437
Mailing address
5300 Ironhorse Pkwy
#436
Dublin, CA 94568-2043
Phone (347) 853-4735
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 |
|---|---|---|---|
| 58408 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252454400000",
"number": "1275761124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 IRONHORSE PKWY",
"address_2": "#436",
"city": "DUBLIN",
"state": "CA",
"postal_code": "945682043",
"telephone_number": "347-853-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2390 COUNTRY HILLS DR",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945097437",
"telephone_number": "925-757-4220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SO",
"first_name": "PATRICK",
"middle_name": "TING",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-30",
"last_updated": "2009-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "58408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.