Divya Reddy Peddireddy, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS62530 Issued in CA

Practice address

3070 Bristol St Ste 180
Costa Mesa, CA 92626-3072

Phone

(714) 924-4824

NPI assigned

Jul 10, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

State licenses

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1356782080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 STONECLIFFE AISLE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926035715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3070 BRISTOL ST STE 180",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263072",
            "telephone_number": "714-924-4824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDIREDDY",
        "first_name": "DIVYA",
        "middle_name": "REDDY",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-10",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS62530",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS62530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Madison Pearson
• Breea Peck
• Brian Anderson Peck
• Kelly Peck
• Nicole Peckham
• Hayley Pedersen
• Pediatric Therapy Services of Orange County, Inc.
• Jada Docuyanan Pedron
• Kristin Brett Pelinka, MD
• Brittnie Pemberton

• Oral and Maxillofacial Surgery (Dentist) in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; 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.