Joan Otomo-Corgel, DDS, MPH

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

25754 Issued in CA

Practice address

1127 Wilshire Blvd
Suite #1110
Los Angeles, CA 90017-3901

Phone

(213) 481-0664

Fax

(213) 481-2902

NPI assigned

Aug 22, 2006

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

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Perio Implant Health Professionals

  • Periodontics
  • Los Angeles, CA
  • NPI 1992914196
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346356045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 MANHATTAN AVE",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662051",
            "telephone_number": "310-546-3239",
            "fax_number": "310-545-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 WILSHIRE BLVD",
            "address_2": "SUITE #1110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900173901",
            "telephone_number": "213-481-0664",
            "fax_number": "213-481-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTOMO-CORGEL",
        "first_name": "JOAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "25754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Otique PC
• Laura Otis, M.D.
• Lee A. Otis III
• Tiana Otis
• Patricia Sherry Oto, INTERN PHARMACIST
• Otonix Inc
• Otosurgical Group Medical Clinic, Inc
• Jonovan Ottenbacher, OD
• Rajani Lolita Ottley, LMFT
• Kristan Nicole Otto, R.D.A

• Periodontics in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.