Active NPI
Ted E Tayenaka, D.D.S.
- General Practice Dentistry
- Los Alamitos, CA
National Provider Identifier
1396895751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 37936
- Practice address
- 3532 Howard Ave
Suite 201
Los Alamitos, CA 90720-3681 - Phone
- (562) 596-0100
- Fax
- (562) 596-0155
- NPI assigned
- Jan 10, 2007
- 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 | 37936 | CA | Primary |
Addresses
Primary practice location
3532 Howard Ave
Suite 201
Los Alamitos, CA 90720-3681
Mailing address
3532 Howard Ave
Suite 201
Los Alamitos, CA 90720-3681
Phone (562) 596-0100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B37936-01 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1396895751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3532 HOWARD AVE",
"address_2": "SUITE 201",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907203681",
"telephone_number": "562-596-0100",
"fax_number": "562-596-0155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3532 HOWARD AVE",
"address_2": "SUITE 201",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907203681",
"telephone_number": "562-596-0100",
"fax_number": "562-596-0155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYENAKA",
"first_name": "TED",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "37936",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B37936-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Los Alamitos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.