Polina Fedorovna Rhoudenko, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

106839 Issued in CA

Practice address

100 Laguna Rd Ste 210
Fullerton, CA 92835-3633

Phone

(714) 716-1783

Fax

(949) 749-6620

NPI assigned

Apr 26, 2021

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1508448861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 WILSHIRE BLVD UNIT 321",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251206",
            "telephone_number": "714-746-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAGUNA RD STE 210",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353633",
            "telephone_number": "714-716-1783",
            "fax_number": "949-749-6620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4060 Fairmount Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921051608",
            "country_code": "US",
            "telephone_number": "619-990-9859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RHOUDENKO",
        "first_name": "POLINA",
        "middle_name": "FEDOROVNA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Reza
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• Yasaman Rezvani
• Leah Rhine
• Sharon Rho
• Ricarda Benz MD, Inc
• Robert Terry Rice, OD
• Richard K. Amo, D.D.S., Inc.
• Kyra Richards
• Laura Lynn Richards

• General Practice Dentistry in Fullerton, CA
• Providers in Fullerton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.