Active NPI
Jonathan Gao
- Orthodontics and Dentofacial Orthopedics Dentistry
- San Diego, CA
National Provider Identifier
1497503676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 105515
- Practice address
- 11368 Fairwind CT
San Diego, CA 92130-8639 - Phone
- (858) 602-2422
- NPI assigned
- May 11, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 105515 | CA | Primary |
Addresses
Primary practice location
11368 Fairwind CT
San Diego, CA 92130-8639
Mailing address
11368 Fairwind CT
San Diego, CA 92130-8639
Phone (858) 602-2422
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 |
|---|---|---|---|
| 105515 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715385600000",
"number": "1497503676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11368 FAIRWIND CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921308639",
"telephone_number": "858-602-2422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11368 FAIRWIND CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921308639",
"telephone_number": "858-602-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAO",
"first_name": "JONATHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-11",
"last_updated": "2024-05-11",
"certification_date": "2024-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "105515",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.