NPIMap

Organization Active NPI

Jka Dental PLLC

  • Dental Clinic/Center
  • Mesa, AZ
National Provider Identifier
1376009175
Registry record updated Feb 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
JKA DENTAL PLLC
Practice address
1905 E McKellips Rd
Mesa, AZ 85203-2865
Phone
(480) 649-1949
NPI assigned
Feb 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2019

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

Authorized official

Name
Dr. Vinh Huynh, D.M.DNPI 1659659142
Title
Dentist/Owner
Phone
(480) 526-3664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1905 E McKellips Rd
Mesa, AZ 85203-2865

Mailing address

1905 E McKellips Rd
Mesa, AZ 85203-2865
Phone (480) 526-3664

Other identifiers 4

IdentifierTypeStateIssuer
1659659142OtherAZPPO AND HMO
1376009175MedicaidAZ
1659659142MedicaidAZ
1376009175OtherAZPPO AND HMO

Other names 1

  • Eastport dental Doing business as

National Provider Directory

National Provider Directory

Locations

1905 E McKellips Rd
Mesa, AZ 85203
Phone (480) 526-3664

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1550275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550361600000",
    "number": "1376009175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 E MCKELLIPS RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852032865",
            "telephone_number": "480-526-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 E MCKELLIPS RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852032865",
            "telephone_number": "480-649-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JKA DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-16",
        "last_updated": "2019-02-17",
        "status": "A",
        "authorized_official_last_name": "HUYNH",
        "authorized_official_first_name": "VINH",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "480-526-3664",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO AND HMO",
            "identifier": "1659659142",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376009175",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659659142",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO AND HMO",
            "identifier": "1376009175",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastport dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2019; 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.