Michael DO, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

49302 Issued in CA

Practice address

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

Phone

(858) 546-1802

NPI assigned

Nov 22, 2010

Sex

Male

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.

• La Jolla Dental Specialty Group

  • Endodontics
  • San Diego, CA
  • NPI 1316171937
  NPD (past)

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1346542545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9133",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "920674133",
            "telephone_number": "858-220-3511"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-22",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "49302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Thanh DO, MSN, APRN, PMHNP-BC
• Han Mai DO, PHARM.D.
• Jennifer Catherine Ariana DO
• Jonathan H. DO, DDS
• Loan Hong DO, CRNA
• Natalie Tram DO, D.O.
• Nicole DO
• Phi DO
• Phuong Thao DO, PHARMD
• Quang DO

• Endodontics in San Diego, CA
• Providers in San Diego, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; 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.