NPIMap

Organization Active NPI

Safoura Massoumi Professional Dental Corp.

Doing business as Children's Primary Dental Group

  • Pediatric Dentistry
  • Chula Vista, CA
National Provider Identifier
1356471460
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
40677 Issued in CA
Legal business name
SAFOURA MASSOUMI PROFESSIONAL DENTAL CORP.
Doing business as
Children's Primary Dental Group
Practice address
397 E Street Suite a
Chula Vista, CA 91910
Phone
(619) 425-9930
Fax
(619) 425-9887
NPI assigned
Mar 7, 2007
Last updated
May 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Authorized official

Name
David Velazquez
Title
Office Manager
Phone
(619) 425-9930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 40677 CA Primary

Addresses

Primary practice location

397 E Street Suite a
Chula Vista, CA 91910

Mailing address

397 E Street Suite a
Chula Vista, CA 91910
Phone (619) 425-9930

Other identifiers 1

IdentifierTypeStateIssuer
G9226502MedicaidCA

Other names 1

  • Children's Primary Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Primary Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

397 E St
Ste A
Chula Vista, CA 91910
Phone (619) 425-9930

Practitioners & affiliated clinicians

Practitioners 4

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1356471460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 E STREET SUITE A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 E STREET SUITE A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFOURA MASSOUMI PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "VELAZQUEZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "619-425-9930"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "40677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9226502",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Primary Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; 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.