Ethan DO, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

103035 Issued in CA

Practice address

3017 Telegraph Ave Ste 310
Berkeley, CA 94705-2049

Phone

(510) 841-7424

NPI assigned

Nov 21, 2018

Last updated

Nov 21, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lin & Jeng DDS Inc

  • General Practice Dentistry
  • Berkeley, CA
  • NPI 1548181530
  NPD (past)

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1467921288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 9TH AVE APT 5",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941222333",
            "telephone_number": "909-538-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 TELEGRAPH AVE STE 310",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052049",
            "telephone_number": "510-841-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-21",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Edward Dister, O.D.
• Michele Ditomas, M.D.
• Patricia G Ditton, PH.D.
• Susan Dix Lyons
• Laura Dixon, ATC
• David William Doan, D.C.
• Sarah Dobro, MD
• Mark Francis Dolan
• Robert Dolgoff, M.D.
• Sonam Dolkar, DNP-FNP

• Dentist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.