Active NPI
Jason Verdi
- General Practice Dentistry
- Lynwood, CA
National Provider Identifier
1396522405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 109294
- Practice address
- 3737 Martin Luther King Jr Blvd Ste 106
Lynwood, CA 90262-3524 - Phone
- (310) 631-1111
- NPI assigned
- Sep 12, 2023
- Last updated
- Sep 12, 2023
- Sex
- Male
- 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 | 109294 | CA | Primary |
Addresses
Primary practice location
3737 Martin Luther King Jr Blvd Ste 106
Lynwood, CA 90262-3524
Mailing address
20345 Ruston Rd
Woodland Hills, CA 91364-5644
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 |
|---|---|---|---|
| 109294 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newbury Park Dental Arts | General Practice | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Newbury Park, CA
- NPI 1013848845
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1396522405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20345 RUSTON RD",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913645644"
},
{
"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": [],
"basic": {
"last_name": "VERDI",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-12",
"last_updated": "2023-09-12",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "109294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.