Active NPI
Piyanut Itarut, DMD
- Dentist
- San Jose, CA
National Provider Identifier
1497121222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN015017
- Practice address
- 6474 McAbee Rd
San Jose, CA 95120-4518 - Phone
- (618) 977-6071
- NPI assigned
- Aug 16, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | DN015017 | GA | Primary |
Addresses
Primary practice location
6474 McAbee Rd
San Jose, CA 95120-4518
Mailing address
3756 La Vista Rd
Suite 102
Tucker, GA 30084-5642
Phone (404) 636-4700
Other names 1
- Pom Itarut
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 |
|---|---|---|---|
| DN015017 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Itarut Dental LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1497121222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3756 LA VISTA RD",
"address_2": "SUITE 102",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845642",
"telephone_number": "404-636-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6474 MCABEE RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951204518",
"telephone_number": "618-977-6071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITARUT",
"first_name": "PIYANUT",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-16",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN015017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "POM",
"last_name": "ITARUT",
"credential": "DMD",
"code": "5",
"type": "Other Name"
}
]
}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 Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.