NPIMap

Organization Active NPI

Siderman, Yampolsky Dental Corporation

  • Dentist
  • Huntington Park, CA
National Provider Identifier
1396949541
Registry record updated Aug 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SIDERMAN, YAMPOLSKY DENTAL CORPORATION
Practice address
6601 Rugby Ave
#400
Huntington Park, CA 90255-4040
Phone
(323) 585-1515
NPI assigned
Jun 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2007

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

Authorized official

Name
Dr. Jerry Siderman, DDSNPI 1386716975
Title
President
Phone
(323) 585-1515

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X

Addresses

Primary practice location

6601 Rugby Ave
#400
Huntington Park, CA 90255-4040

Mailing address

6601 Rugby Ave
#400
Huntington Park, CA 90255-4040
Phone (323) 585-1515

Other identifiers 1

IdentifierTypeStateIssuer
G91803MedicaidCA

National Provider Directory

National Provider Directory

Locations

6601 Rugby Ave
Ste 400
Huntington Park, CA 90255
Phone (323) 585-1515

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1396949541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 RUGBY AVE",
            "address_2": "#400",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554040",
            "telephone_number": "323-585-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 RUGBY AVE",
            "address_2": "#400",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554040",
            "telephone_number": "323-585-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDERMAN, YAMPOLSKY DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "SIDERMAN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-585-1515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91803",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.

Verify at the official NPI Registry.