Individual provider Active NPI

Tyler Kuwamoto, DMD

  • Dentist
  • San Diego, CA
National Provider Identifier
1306519079
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
106583 Issued in CA
Practice address
4276 54TH PL
San Diego, CA 92115-6011
Phone
(619) 256-0566
NPI assigned
Jul 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 106583 CA Primary

Addresses

Primary practice location

4276 54TH PL
San Diego, CA 92115-6011

Mailing address

5048 Merrimac CT
San Diego, CA 92117-1001

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

LicenseStateTypeSpecialty
106583CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Kuwamoto DMD Inc. CurrentSince Sep 25, 2022 Accepting new patients

Locations

4276 54th Pl
San Diego, CA 92115
Phone (619) 256-0566

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1306519079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5048 MERRIMAC CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921171001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4276 54TH PL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921156011",
            "telephone_number": "619-256-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUWAMOTO",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.