Winston Muditajaya, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44515 Issued in CA

Practice address

9123 Slauson Ave
Pico Rivera, CA 90660-4522

Phone

(562) 949-0177

Fax

(562) 949-4776

NPI assigned

Jul 17, 2006

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

Not listed in the public Medicare enrollment file

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.

• Muditajaya Dental Corporation

  • General Practice Dentistry
  • Pico Rivera, CA
  • NPI 1942381066
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1366469017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9123 SLAUSON AVE",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604522",
            "telephone_number": "562-949-0177",
            "fax_number": "562-949-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9123 SLAUSON AVE",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906604522",
            "telephone_number": "562-949-0177",
            "fax_number": "562-949-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDITAJAYA",
        "first_name": "WINSTON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle A Moreno
• Tammy Renee Morgan
• Michael Morkos, LMFT
• Muditajaya Dental Corporation
• Danny Muditajaya, DDS
• Andrea Mundo
• Maria Iveli Munoz
• Mariana Soledad Murrieta
• N&J Speech Therapy Services
• Leticia Najera

• General Practice Dentistry in Pico Rivera, CA
• Providers in Pico Rivera, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.