John R Licking, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21321 Issued in CA

Practice address

730 Altos Oaks Dr
Los Altos, CA 94024-5401

Phone

(408) 736-6255

Fax

(408) 736-6100

NPI assigned

Nov 9, 2005

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

Other identifiers 1

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

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1376524140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245401",
            "telephone_number": "408-736-6255",
            "fax_number": "408-736-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245401",
            "telephone_number": "408-736-6255",
            "fax_number": "408-736-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICKING",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "21321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA",
            "identifier": "21321",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Maura Levitan, M.D.
• Nicole Lew, DPT
• Sherwin D Lewis, MD
• Jennifer Salz Lezin, L.C.S.W.
• Jiexuan Li, LMHC
• Amanda Liew, PA-C, MSPAS
• Kathryn Lige, LCSW
• Hae Jin Lim, CNP
• Irene Lin
• Yui Kuo Lin, R.PH

• General Practice Dentistry in Los Altos, CA
• Providers in Los Altos, 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 Sep 10, 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.