NPIMap

Organization Active NPI

I Zak DDS Prof Dental Corp

  • Dentist
  • Temecula, CA
National Provider Identifier
1386163483
Registry record updated Sep 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
38238 Issued in CA
Legal business name
I ZAK DDS PROF DENTAL CORP
Practice address
41593 Winchester Rd Ste 211
Temecula, CA 92590-4857
Phone
(951) 296-3366
NPI assigned
Sep 11, 2017
Last updated
Sep 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2017

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

Authorized official

Name
Dr. Ilya Zak, DDSNPI 1023165255
Title
Owner Ceo
Phone
(310) 706-5273

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
Dentist 122300000X 38238 CA Primary

Addresses

Primary practice location

41593 Winchester Rd Ste 211
Temecula, CA 92590-4857

Mailing address

3355 Cochran St Ste 206
Simi Valley, CA 93063-2532
Phone (310) 503-9277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231220003181 CA Part B Supplier - Clinic/Group Practice 9133579808 Receives reassigned benefits from 20 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Temecula, CA; Whittier, CA; Ventura, CA; Valencia, CA; Simi Valley, CA; Santa Barbara, CA; San Diego, CA; Long Beach, CA…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
I Zak DDS Prof Dental Corp14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

5029 Kanan Rd
Agoura Hills, CA 91301
Phone (818) 991-9852

5625 Ruffin Rd
Ste 200
San Diego, CA 92123
Phone (858) 569-9651

1120 Via Verde
San Dimas, CA 91773
Phone (909) 599-2444

3355 Cochran St
Ste 206
Simi Valley, CA 93063
Phone (805) 520-1100

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505088000000",
    "number": "1386163483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 COCHRAN ST STE 206",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930632532",
            "telephone_number": "310-503-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41593 WINCHESTER RD STE 211",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925904857",
            "telephone_number": "951-296-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I ZAK DDS PROF DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-11",
        "status": "A",
        "authorized_official_last_name": "ZAK",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "310-706-5273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "38238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.