Stephanie Clark, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

104042 Issued in CA

Practice address

5464 South St
Ste a
Lakewood, CA 90712

Phone

(253) 279-3647

NPI assigned

Jul 19, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1336792233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E 1ST ST # 197",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5464 SOUTH ST",
            "address_2": "STE A",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "90712",
            "telephone_number": "253-279-3647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHANIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "104042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104042",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ae Sook Choi, FIT001CA
• Kevin NMN Choi, DDS
• Ivan Miguel Choy
• Christy H. Thai, D.D.S., Inc. (Lakewood Modern Dentistry)
• Ngoc Felix Chu, PHARM.D.
• Kayla Clarke
• Emma L Clay, M.D.
• Stephen Cobb
• Thomas P Collopy, M.D.
• Christopher John Combs, M.D.

• Dentist in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Dentist in California

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