NPIMap

Individual provider Active NPI

Tarkan Sidal, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • San Diego, CA
National Provider Identifier
1407036502
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
A122601 Issued in CA
Practice address
8008 Frost St
Suite 311
San Diego, CA 92123-4205
Phone
(858) 292-6033
NPI assigned
Nov 7, 2007
Last updated
Jul 21, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X OMS 101 CA
Dentist 122300000X 019-027754 IL
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X A122601 CA Primary

Addresses

Primary practice location

8008 Frost St
Suite 311
San Diego, CA 92123-4205

Mailing address

8008 Frost St
Suite 311
San Diego, CA 92123-4205
Phone (858) 292-6033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171013001309 CA Practitioner - Oral Surgery 1153696380 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Allies Clinic IncGroup PAC ID 8527458389, 16 clinicians
Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians

Practice addresses (Care Compare)

5395 Ruffin Rd
Suite 102
San Diego, CA 92123-1338
Phone (858) 598-5291

7901 Frost St
San Diego, CA 92123-2701
Phone (858) 939-3400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
019-027754ILMDDentist
OMS 101CAMDOral and Maxillofacial Surgery (Dentist)
A122601CAMDOral & Maxillofacial Surgery (D.M.D.)
101CAMDCertified Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Aug 19, 2017 Accepting new patients
Scripps Health Current Accepting new patients
Health Allies Clinic Inc Oral and Maxillofacial Surgery CurrentSince Jan 1, 2024 Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

5395 Ruffin Rd
Ste 102
San Diego, CA 92123
Phone (858) 569-8959

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Interoperability endpoints

  • Direct secure messaging: tsidal27514@scrippshlth.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1407036502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8008 FROST ST",
            "address_2": "SUITE 311",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234205",
            "telephone_number": "858-292-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 FROST ST",
            "address_2": "SUITE 311",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234205",
            "telephone_number": "858-292-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDAL",
        "first_name": "TARKAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-07",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "OMS 101",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-027754",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "A122601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.