Jasmine L Dermawan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

57711 Issued in CA

Practice address

8231 E Stockton Blvd Ste D
Sacramento, CA 95828-8202

Phone

(916) 368-3080

Fax

(916) 405-6551

NPI assigned

Aug 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jdermawan769769@direct.ochin.org

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1326239773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 AMERICAN RIVER DR STE 307",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958257088",
            "telephone_number": "916-929-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8231 E STOCKTON BLVD STE D",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958288202",
            "telephone_number": "916-368-3080",
            "fax_number": "916-405-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERMAWAN",
        "first_name": "JASMINE",
        "middle_name": "L",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "9559",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "57711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1301071",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Holly Derkacs, M.D.
• Andrea Derlet, PHARMD
• Mikla Nina Derlet, MD
• Robert W Derlet, MD
• Dermatology Consultants of Sacramento a Medical Corp
• Bernard Lawson Derock, RN,CADC
• Camille Derome Polik, DO
• Alexandra Lauren Derosa, LMSW
• Danielle Derosa, PA-C
• Kelli Linn Derrah

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.