Y.a.Satyarahardja DDS.Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

46955 Issued in CA

Legal business name

Y.A.SATYARAHARDJA DDS.INC.

Practice address

2520 E Workman Ave
West Covina, CA 91791-1534

Phone

(626) 966-0300

Fax

(696) 966-0336

NPI assigned

Nov 13, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yintawati Satyarahardja, DDS

Title

President

Phone

(626) 966-0300

Specialties & licenses 1

Addresses

Other names 1

• Citrus Grove Dental Doing business as

Locations

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1508296450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 E WORKMAN AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911534",
            "telephone_number": "626-966-0300",
            "fax_number": "696-966-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 E WORKMAN AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911534",
            "telephone_number": "626-966-0300",
            "fax_number": "696-966-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "Y.A.SATYARAHARDJA DDS.INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "SATYARAHARDJA",
        "authorized_official_first_name": "YINTAWATI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-966-0300",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "46955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citrus Grove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindsey Wylie-Gruen
• Kelsey Wyman Chin, MS, CF-SLP
• Wynee Xiang
• Xiaofang Yuki Lu DDS a Professional Dental Corporation
• Qun Xu, M.D.
• Alyssa Yacoub
• Matthew Yaggie
• George T Yang, M.D.
• Hsin-Yi Yang, AU.D.
• Justin Tyng Lun Yang, DDS

• Dentist in West Covina, CA
• Providers in West Covina, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.