Mark R Medina & Thomas Kerrian

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

31129 Issued in CA

Legal business name

MARK R MEDINA & THOMAS KERRIAN

Doing business as

Rancho Penasquitos Dental Center

Practice address

9955 Carmel Mountain Rd Ste 4
San Diego, CA 92129-2815

Phone

(858) 484-3100

Fax

(858) 484-8510

NPI assigned

Aug 20, 2006

Last updated

Jul 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas J Kerrian, D.M.D.NPI 1376886762

Title

Dentist

Phone

(858) 484-3100

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Rancho Penasquitos Dental Center Doing business as

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.

• Thomas J Kerrian, DMD

  • Dentist
  • San Diego, CA
  • NPI 1376886762
  NPD (past) Authorized official
• Mark R Medina, DDS

  • Dentist
  • San Diego, CA
  • NPI 1932442332
  NPD (past)
• Pavneet Sondhi, D.D.S.

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1568601045
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1417062472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9955 CARMEL MOUNTAIN RD STE 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292815",
            "telephone_number": "858-484-3100",
            "fax_number": "858-484-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9955 CARMEL MOUNTAIN RD STE 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292815",
            "telephone_number": "858-484-3100",
            "fax_number": "858-484-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK R MEDINA & THOMAS KERRIAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "KERRIAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "858-484-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "25595",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "31129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "25595",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "31129",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rancho Penasquitos Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mark S. Austerlitz, M.D., a Medical Corporation
• Mark W. Bondi, PHD, Abpp-CN, Psychologist, Apc (Beacon Neuropsychology)
• Leslie Alison Mark, M.D.
• Michael B Mark, MS, MA
• Nicole Whitney Mark

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.