Gina Shaker, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

109370 Issued in CA

Practice address

4170 Admiralty Way Unit 325
Marina del Rey, CA 90292-6219

Phone

(949) 742-2747

NPI assigned

Sep 12, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1437936465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 ADMIRALTY WAY UNIT 325",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926219",
            "telephone_number": "949-742-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 ADMIRALTY WAY UNIT 325",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926219",
            "telephone_number": "949-742-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKER",
        "first_name": "GINA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dene Logan Selkin
• Nicole Alexandra Sellers-Hansen, R.D.N
• Mary D Senatore
• James Daffin Senechal, MD
• Harshil Shah
• Joel Shapiro, M.D.
• Grant Daniel Shifflett, M.D.
• Loraine Sue Shimada, R.D.
• Steven Shimoyama, M.D.
• Phoebe Park Shinn, PMHNP-BC

• Dentist in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.