NPIMap

Organization Active NPI

Agung Pribadi DDS Inc

  • General Practice Dentistry
  • La Habra, CA
National Provider Identifier
1295830487
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
45519 Issued in CA
Legal business name
AGUNG PRIBADI DDS INC
Practice address
600 E Whittier Blvd
La Habra, CA 90631
Phone
(562) 691-3070
Fax
(562) 691-7198
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Authorized official

Name
Agung Pribadi, DDSNPI 1235378498
Title
Ceo
Phone
(562) 691-3070

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 45519 CA Primary

Addresses

Primary practice location

600 E Whittier Blvd
La Habra, CA 90631

Mailing address

600 E Whittier Blvd
La Habra, CA 90631
Phone (562) 691-3070

National Provider Directory

National Provider Directory

Locations

600 E Whittier Blvd
La Habra, CA 90631
Phone (562) 691-3070

Practitioners & affiliated clinicians

Practitioners 2

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": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1295830487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E WHITTIER BLVD",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "90631",
            "telephone_number": "562-691-3070",
            "fax_number": "562-691-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E WHITTIER BLVD",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "90631",
            "telephone_number": "562-691-3070",
            "fax_number": "562-691-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGUNG PRIBADI DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "PRIBADI",
        "authorized_official_first_name": "AGUNG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-691-3070",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Habra, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; 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.