Active NPI
Audrey Lee Wingo
- General Practice Dentistry
- Seaside, CA
National Provider Identifier
1376857771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 59475
- Practice address
- 1513 Fremont Blvd # E-2
Seaside, CA 93955-4319 - Phone
- (831) 324-4492
- NPI assigned
- Jul 28, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 59475 | CA | Primary |
Addresses
Primary practice location
1513 Fremont Blvd # E-2
Seaside, CA 93955-4319
Mailing address
6484 Cooper St
Felton, CA 95018-9402
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
| License | State | Type | Specialty |
|---|---|---|---|
| 59475 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suman Ramakumar DDS Inc | General Practice | Past | Accepting new patients |
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": "1280275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1376857771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6484 COOPER ST",
"city": "FELTON",
"state": "CA",
"postal_code": "950189402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 FREMONT BLVD # E-2",
"city": "SEASIDE",
"state": "CA",
"postal_code": "939554319",
"telephone_number": "831-324-4492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINGO",
"first_name": "AUDREY",
"middle_name": "LEE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-28",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "59475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seaside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.