NPIMap

Organization Active NPI

Bina, Korouri, Sage Dental Corporation

Doing business as PHD Dental Group

  • General Practice Dentistry
  • Lynwood, CA
National Provider Identifier
1396096228
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BINA, KOROURI, SAGE DENTAL CORPORATION
Doing business as
PHD Dental Group
Practice address
3737 Martin Luther King Jr Blvd Ste 106
Lynwood, CA 90262-3524
Phone
(310) 631-1111
NPI assigned
Oct 2, 2012
Last updated
Jun 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Authorized official

Name
Dr. Pedram Bina, DDSNPI 1134300866
Title
Ceo
Phone
(310) 433-2722

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
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3737 Martin Luther King Jr Blvd Ste 106
Lynwood, CA 90262-3524

Mailing address

3737 Martin Luther King Jr Blvd
106
Lynwood, CA 90262-3513
Phone (323) 266-5737

Other practice location 1

3737 Martin Luther King Jr Blvd Ste 375
Lynwood, CA 90262-3532
Phone (310) 631-1111

Other names 1

  • PHD Dental Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140610002395 CA Part B Supplier - Clinic/Group Practice 3779707849 Receives reassigned benefits from 3 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Inglewood, CA; Pico Rivera, CA; Lynwood, CA; Los Angeles, CA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Bina Korouri Sage Dental Corporation6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

3000 Whittier Blvd
Los Angeles, CA 90023
Phone (323) 269-5437

3737 Martin Luther King Jr Blvd
Ste 106
Lynwood, CA 90262
Phone (310) 631-1111

3737 Martin Luther King Jr Blvd
Ste 375
Lynwood, CA 90262
Phone (310) 631-1111

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1396096228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 MARTIN LUTHER KING JR BLVD",
            "address_2": "106",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623513",
            "telephone_number": "323-266-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MARTIN LUTHER KING JR BLVD STE 106",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623524",
            "telephone_number": "310-631-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3737 Martin Luther King Jr Blvd Ste 375",
            "address_purpose": "LOCATION",
            "city": "Lynwood",
            "state": "CA",
            "postal_code": "902623532",
            "country_code": "US",
            "telephone_number": "310-631-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BINA, KOROURI, SAGE DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "BINA",
        "authorized_official_first_name": "PEDRAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-433-2722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHD Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynwood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.