Active NPI
Lidia Shamis
- General Practice Dentistry
- San Jose, CA
National Provider Identifier
1467676809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 37738
- Practice address
- 5150 Graves Avenue
San Jose, CA 95129 - Phone
- (408) 252-0629
- Fax
- (408) 252-0629
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 37738 | CA | Primary |
Addresses
Primary practice location
5150 Graves Avenue
San Jose, CA 95129
Mailing address
105 Avila Rd
San Mateo, CA 94402
Phone (650) 358-4009
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 |
|---|---|---|---|
| 37738 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467676809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 AVILA RD",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "94402",
"telephone_number": "650-358-4009",
"fax_number": "650-358-4009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5150 GRAVES AVENUE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95129",
"telephone_number": "408-252-0629",
"fax_number": "408-252-0629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMIS",
"first_name": "LIDIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "37738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.