Regents of the University of UCLA Maxillofacial Prosthodontics

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

38370 Issued in CA

Legal business name

REGENTS OF THE UNIVERSITY OF UCLA MAXILLOFACIAL PROSTHODONTICS

Doing business as

UCLA Maxillofacial Prosthetics

Practice address

10833 Le Conte Ave RM Ao-156a CHS
Box 951668
Los Angeles, CA 90095-3075

Phone

(310) 825-6510

Fax

(310) 206-4201

NPI assigned

Jan 30, 2007

Last updated

Dec 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eric C Sung, DDSNPI 1629161351

Title

Director

Phone

(310) 206-6407

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UCLA Maxillofacial Prosthetics Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eric C. Sung, DDS

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1629161351
  Medicare reassignment Authorized official
• John E. Beumer III, DDS,MS

  • Prosthodontics
  • Los Angeles, CA
  • NPI 1184836702
  Medicare reassignment
• Evelyn Chung, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1508075730
  NPD
• Faraz Tavoossi, DDS

  • Student in an Organized Health Care Education/Training Program
  • Los Angeles, CA
  • NPI 1902392566
  NPD (past)
• Alina Maria Miller, DDS

  • Dentist
  • Spring, TX
  • NPI 1396372736
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1285771378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE RM AO-156A",
            "address_2": "BOX 951668",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-825-6510",
            "fax_number": "310-206-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE RM AO-156A CHS",
            "address_2": "BOX 951668",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-825-6510",
            "fax_number": "310-206-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF UCLA MAXILLOFACIAL PROSTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "SUNG",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "310-206-6407",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "38370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91297",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCLA Maxillofacial Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Regents of the University of California (UCLA Emergency Medical Services)
• Regents of the University of California
• Regents of the University of California Los Angeles (UCLA Orofacial Pain)
• Regents of the University of California Los Angeles
• Regents of the University of California UCLA Ashe Center (Arthur Ashe Student Health and Wellness Center)
• Regents of Univ. of California Dental Anesthesia Service
• Regents of University of California (UCLA Dental Radiology Practice)
• Regents of University of California at Los Angeles (Ucla Perinatal Group)
• Regents of University of California Los Angeles (UCLA Orofacial Pain Clinic)
• Regents of University of California Simms Mann UCLA (Reflections Boutique)

• Prosthodontics in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.