NPIMap

Organization Active NPI

Boudaie Dental PC

  • Dentist
  • El Segundo, CA
National Provider Identifier
1306488341
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BOUDAIE DENTAL PC
Doing business as
Ruby Dental Care
Practice address
630 N Pacific Coast Hwy Ste 15
El Segundo, CA 90245-3435
Phone
(310) 341-3041
Fax
(310) 341-3328
NPI assigned
Oct 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Alex Boudaie, DDS
Title
President
Phone
(310) 341-3041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

630 N Pacific Coast Hwy Ste 15
El Segundo, CA 90245-3435

Mailing address

630 N Pacific Coast Hwy Ste 15
El Segundo, CA 90245-3435
Phone (310) 341-3041

Other names 1

  • Ruby Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

630 N Pacific Coast Hwy
Ste 15
El Segundo, CA 90245
Phone (310) 341-3041

NPI Registry JSON

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1306488341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 N PACIFIC COAST HWY STE 15",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453435",
            "telephone_number": "310-341-3041",
            "fax_number": "310-341-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N PACIFIC COAST HWY STE 15",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453435",
            "telephone_number": "310-341-3041",
            "fax_number": "310-341-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUDAIE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "BOUDAIE",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-341-3041",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ruby Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.