Individual provider Active NPI

Justin Ghiam, D.D.S.

  • Dentist
  • Norwalk, CA
National Provider Identifier
1366857690
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63508 Issued in CA
Practice address
11762 Firestone Blvd
Norwalk, CA 90650-2898
Phone
(562) 667-5437
NPI assigned
Jun 25, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 63508 CA Primary

Addresses

Primary practice location

11762 Firestone Blvd
Norwalk, CA 90650-2898

Mailing address

11762 Firestone Blvd
Norwalk, CA 90650-2898

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
63508CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Justin Ghiam, D.D.S., Inc. Dentist CurrentSince Oct 2, 2022 Accepting new patients

Locations

11762 Firestone Blvd
Norwalk, CA 90650
Phone (562) 667-5437

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1366857690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 FIRESTONE BLVD",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11762 FIRESTONE BLVD",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502898",
            "telephone_number": "562-667-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHIAM",
        "first_name": "JUSTIN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.