NPIMap

Organization Active NPI

La Jolla Dental Specialty Group

  • Endodontics
  • San Diego, CA
National Provider Identifier
1316171937
Registry record updated May 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
47399 Issued in CA
Legal business name
LA JOLLA DENTAL SPECIALTY GROUP
Practice address
4510 Executive Dr
Suite 205
San Diego, CA 92121-3021
Phone
(858) 546-1802
Fax
(858) 546-1242
NPI assigned
May 11, 2009
Last updated
May 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2009

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

Authorized official

Name
Duke Huynh Nguyen, D.D.S
Title
Owner
Phone
(858) 546-1802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 47399 CA Primary

Addresses

Primary practice location

4510 Executive Dr
Suite 205
San Diego, CA 92121-3021

Mailing address

4510 Executive Dr
Suite 205
San Diego, CA 92121-3021
Phone (858) 546-1802

National Provider Directory

National Provider Directory
Tax ID family
La Jolla Dental Specialty Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1316171937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DR",
            "address_2": "SUITE 205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213021",
            "telephone_number": "858-546-1802",
            "fax_number": "858-546-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DR",
            "address_2": "SUITE 205",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213021",
            "telephone_number": "858-546-1802",
            "fax_number": "858-546-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA JOLLA DENTAL SPECIALTY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "DUKE",
        "authorized_official_middle_name": "HUYNH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-546-1802",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "47399",
            "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 May 11, 2009; 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.