Kathryn Rose Bermoy, DDS
Individual provider Active NPI General Practice Dentistry · Lawndale, CA
NPI 1386823219 · NPPES record last updated Jan 16, 2008
Key facts
- NPI
- 1386823219
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 56146 (CA)
- Practice address
- 4310 Marine Ave
Lawndale, CA 90260-1528 - Phone
- (310) 408-8004
- NPI assigned
- Oct 27, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160111001189 | CA | Order and Referring Only - Dentist |
6800198649 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56146 | CA | MD | Pharmacist |
Interoperability endpoints
- kathryn.bermoy.p1@direct.nevhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56146 | CA | Yes |
Addresses
Primary practice location
4310 Marine Ave
Lawndale, CA 90260-1528
Mailing address
4310 Marine Ave
Lawndale, CA 90260-1528
Phone (310) 408-8004
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- Dominga Lim Rarugal Bermoy
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- Best Plastic Surgery Practice Inc
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All providers in Lawndale, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.