NPIMap

Individual provider Active NPI

Xaver Bondoc Pangilinan, RDH

  • Dental Hygienist
  • Los Angeles, CA
National Provider Identifier
1356588990
Registry record updated Mar 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
30965 Issued in CA
Practice address
1423 E Gage Ave
Suite a
Los Angeles, CA 90001-1771
Phone
(323) 983-4000
Fax
(323) 983-4007
NPI assigned
Jan 20, 2009
Last updated
Mar 17, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 30965 CA Primary
Dental Assistant 126800000X 70539 CA

Addresses

Primary practice location

1423 E Gage Ave
Suite a
Los Angeles, CA 90001-1771

Mailing address

16056 Lancet Dr
Whittier, CA 90603-2597
Phone (310) 951-6193

Other identifiers 2

IdentifierTypeStateIssuer
70539OtherCARDA LICENSE
30965OtherCADHCC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
30965CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cohen Sedgh, Manavi & Pakravan Dental Corporation Past Accepting new patients
Ryan Sein Chein Lee Dental Corporation Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489708800000",
    "number": "1356588990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16056 LANCET DR",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906032597",
            "telephone_number": "310-951-6193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 E GAGE AVE",
            "address_2": "SUITE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900011771",
            "telephone_number": "323-983-4000",
            "fax_number": "323-983-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANGILINAN",
        "first_name": "XAVER",
        "middle_name": "BONDOC",
        "name_prefix": "Mr.",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-20",
        "last_updated": "2017-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "30965",
            "primary": true
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "70539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RDA LICENSE",
            "identifier": "70539",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHCC",
            "identifier": "30965",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; 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.