NPIMap

Organization Active NPI

Mimi Theerathada Dental Corporation

  • General Practice Dentistry
  • Westminster, CA
National Provider Identifier
1417483371
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
56371 Issued in CA
Legal business name
MIMI THEERATHADA DENTAL CORPORATION
Practice address
9972 Bolsa Ave
102
Westminster, CA 92683-6069
Phone
(714) 839-3112
NPI assigned
May 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Dr. Mimi Theerathada, DMDNPI 1528256369
Title
Doctor
Phone
(714) 839-3112

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 56371 CA Primary

Addresses

Primary practice location

9972 Bolsa Ave
102
Westminster, CA 92683-6069

Mailing address

9972 Bolsa Ave
102
Westminster, CA 92683-6069
Phone (714) 839-3112

National Provider Directory

National Provider Directory

Locations

9972 Bolsa Ave
Ste 102
Westminster, CA 92683
Phone (714) 839-3112

Practitioners & affiliated clinicians

Practitioners 4

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": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1417483371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9972 BOLSA AVE",
            "address_2": "102",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836069",
            "telephone_number": "714-839-3112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9972 BOLSA AVE",
            "address_2": "102",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836069",
            "telephone_number": "714-839-3112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMI THEERATHADA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "THEERATHADA",
        "authorized_official_first_name": "MIMI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "714-839-3112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.