Active NPI
Andy Dinh
- Dentist
- Los Angeles, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 108844
- Practice address
- 714 Tiverton Ave
Los Angeles, CA 90095-8361 - Phone
- (310) 825-9789
- NPI assigned
- May 12, 2021
- Last updated
- Dec 27, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 108844 | CA | Primary |
Addresses
Primary practice location
714 Tiverton Ave
Los Angeles, CA 90095-8361
Mailing address
10870 Wellworth Ave
Los Angeles, CA 90024-4917
Phone (916) 267-9273
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108844 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current | Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current | Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro Inc | Current | Accepting new patients |
Locations
1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780
1136 D Ave
National City, CA 91950
Phone (619) 336-2300
1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba San Ysidro Health Precision Park
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1124782685
-
dba San Ysidro Health Senior Dental Center
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1457033813
-
dba San Diego PACE Vista
- PACE Provider Organization
- Vista, CA
- NPI 1124793732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1386228518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10870 WELLWORTH AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900244917",
"telephone_number": "916-267-9273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 TIVERTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958361",
"telephone_number": "310-825-9789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DINH",
"first_name": "ANDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-12",
"last_updated": "2023-12-27",
"certification_date": "2023-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "108844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; 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.