L Swayamprakasam DDS Corp

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

100140 Issued in CA

Legal business name

L SWAYAMPRAKASAM DDS CORP

Doing business as

SEASIDE PERIO CENTRE

Practice address

1550 Lombard St
San Francisco, CA 94123-3154

Phone

(669) 245-7494

Fax

(669) 265-0400

NPI assigned

Jun 11, 2018

Organization subpart

No

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

Authorized official

Name

Logesh Swayamprakasam

Title

President

Phone

(224) 877-0645

Specialties & licenses 1

Addresses

Other names 1

• SEASIDE PERIO CENTRE Doing business as

Locations

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1508359902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 BEACON AVE APT B320",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945383033",
            "telephone_number": "224-877-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 LOMBARD ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941233154",
            "telephone_number": "669-245-7494",
            "fax_number": "669-265-0400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43625 Mission Blvd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945395800",
            "country_code": "US",
            "telephone_number": "669-245-7494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3465 McKee Rd",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951272233",
            "country_code": "US",
            "telephone_number": "669-245-7494",
            "fax_number": "669-265-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "L SWAYAMPRAKASAM DDS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "SWAYAMPRAKASAM",
        "authorized_official_first_name": "LOGESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "224-877-0645"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "100140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEASIDE PERIO CENTRE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Periodontics in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.