NPIMap

Individual provider Active NPI

Yeni Sutanto, D.D.S

  • General Practice Dentistry
  • Van Nuys, CA
National Provider Identifier
1508876277
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
39212 Issued in CA
Practice address
6931 Van Nuys Blvd
Suite, #100
Van Nuys, CA 91405-3937
Phone
(818) 988-8080
Fax
(818) 988-8168
NPI assigned
Aug 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 39212 CA Primary

Addresses

Primary practice location

6931 Van Nuys Blvd
Suite, #100
Van Nuys, CA 91405-3937

Mailing address

6931 Van Nuys Blvd
Suite, #100
Van Nuys, CA 91405-3937
Phone (818) 988-8080

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vanowen Dental Center Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508876277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6931 VAN NUYS BLVD",
            "address_2": "SUITE, #100",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053937",
            "telephone_number": "818-988-8080",
            "fax_number": "818-988-8168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6931 VAN NUYS BLVD",
            "address_2": "SUITE, #100",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053937",
            "telephone_number": "818-988-8080",
            "fax_number": "818-988-8168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTANTO",
        "first_name": "YENI",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.