Steven A Miyamoto, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

42368 Issued in CA

Practice address

113 W. Amerige Ave
Fullerton, CA 92832

Phone

(714) 525-1178

Fax

(714) 879-6235

NPI assigned

Apr 8, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 23, 2015 through Nov 23, 2027

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Steven a Miyamoto, DDS, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fullerton, CA
  • NPI 1477090744
  NPD (past) Authorized official

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443484800000",
    "number": "1508039827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 W. AMERIGE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92832",
            "telephone_number": "714-525-1178",
            "fax_number": "714-879-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W. AMERIGE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92832",
            "telephone_number": "714-525-1178",
            "fax_number": "714-879-6235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYAMOTO",
        "first_name": "STEVEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-08",
        "last_updated": "2015-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "42368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Isaiah Mitchell
• Jessica Loren Mitchell
• Lauren Mitchell
• Leslie Allyson Mitchell
• Sinclair Mitchell, AMFT
• Nobue Miyao-Baloy
• Jenny Jeyoung Mo
• Justin Randall Mobley
• Brandon Thomas Mock, PA-C
• Sean Moghadam

• Oral and Maxillofacial Surgery (Dentist) in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.