Active NPI
Willy Shea, DDS
- Dentist
- Norwalk, CA
National Provider Identifier
1275813115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50679
- Practice address
- 12258 Hermosura St
Norwalk, CA 90650-6751 - Phone
- (951) 280-0679
- NPI assigned
- Aug 24, 2011
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 50679 | CA | Primary |
Addresses
Primary practice location
12258 Hermosura St
Norwalk, CA 90650-6751
Mailing address
12258 Hermosura St
Norwalk, CA 90650-6751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160413002502 | CA | Order and Referring Only - Oral Surgery | 0648578377 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314144000000",
"number": "1275813115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12258 HERMOSURA ST",
"city": "NORWALK",
"state": "CA",
"postal_code": "906506751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12258 HERMOSURA ST",
"city": "NORWALK",
"state": "CA",
"postal_code": "906506751",
"telephone_number": "951-280-0679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "WILLY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-24",
"last_updated": "2011-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "50679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwalk, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.