Active NPI
Garrick Scott Hong, D.D.S
- General Practice Dentistry
- Oakland, CA
National Provider Identifier
1518170059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 53999
- Practice address
- 3050 E. 16TH St.
Fruitvale Dental
Oakland, CA 94601-2319 - Phone
- (510) 535-4700
- Fax
- (510) 535-4283
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS53999 | CA | |
| General Practice Dentistry | 1223G0001X | 53999 | CA | Primary |
Addresses
Primary practice location
3050 E. 16TH St.
Fruitvale Dental
Oakland, CA 94601-2319
Mailing address
P.O. Box 22210
Oakland, CA 94623-2210
Phone (510) 535-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130927000660 | CA | Order and Referring Only - Oral Surgery | 4082848312 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS53999 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica de la Raza Inc | Past | Accepting new patients | |
| La Clinica de la Raza Inc | Past | Accepting new patients |
Interoperability endpoints
- ghong306577@direct.ochin.org
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Oakland, CA
- NPI 1326154360
-
- Federally Qualified Health Center (FQHC)
- Oakland, CA
- NPI 1346262292
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377216000000",
"number": "1518170059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 22210",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946232210",
"telephone_number": "510-535-4000",
"fax_number": "510-535-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3050 E. 16TH ST.",
"address_2": "FRUITVALE DENTAL",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012319",
"telephone_number": "510-535-4700",
"fax_number": "510-535-4283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HONG",
"first_name": "GARRICK",
"middle_name": "SCOTT",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2013-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS53999",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "53999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.