Active NPI
Danny Muditajaya, DDS
- Dentist
- Pico Rivera, CA
National Provider Identifier
1467572156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30419
- Practice address
- 9123 Slauson Ave
Pico Rivera, CA 90660-4522 - Phone
- (562) 949-0177
- Fax
- (562) 949-4776
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30419 | CA | Primary |
Addresses
Primary practice location
9123 Slauson Ave
Pico Rivera, CA 90660-4522
Mailing address
9123 Slauson Ave
Pico Rivera, CA 90660-4522
Phone (562) 949-0177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30419 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winston Muditajaya Dental Corporation | Dentist | Past | Accepting new patients |
| Muditajaya Dental Corporation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Pico Rivera, CA
- NPI 1942381066
-
- Dentist
- Pico Rivera, CA
- NPI 1356706022
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268092800000",
"number": "1467572156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9123 SLAUSON AVE",
"city": "PICO RIVERA",
"state": "CA",
"postal_code": "906604522",
"telephone_number": "562-949-0177",
"fax_number": "562-949-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9123 SLAUSON AVE",
"city": "PICO RIVERA",
"state": "CA",
"postal_code": "906604522",
"telephone_number": "562-949-0177",
"fax_number": "562-949-4776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDITAJAYA",
"first_name": "DANNY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2010-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "30419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pico Rivera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.