Individual provider Active NPI

Thomas J Poksay, D.M.D.

  • General Practice Dentistry
  • Novato, CA
National Provider Identifier
1528079647
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
33831 Issued in CA
Practice address
330 Ignacio Blvd
Suite 102
Novato, CA 94949-6036
Phone
(415) 883-0588
Fax
(415) 883-0591
NPI assigned
Aug 11, 2006
Sex
Male
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 33831 CA Primary

Addresses

Primary practice location

330 Ignacio Blvd
Suite 102
Novato, CA 94949-6036

Mailing address

330 Ignacio Blvd
Suite 102
Novato, CA 94949-6036
Phone (415) 883-0588

Other identifiers 1

IdentifierTypeStateIssuer
637324OtherCAUNITED CONCORDIA INS.

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150824000065 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5294040044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33831CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
S. Ramteen Rafii, DDS, Dental Corp. PastSince Jun 23, 2025 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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528079647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 IGNACIO BLVD",
            "address_2": "SUITE 102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496036",
            "telephone_number": "415-883-0588",
            "fax_number": "415-883-0591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 IGNACIO BLVD",
            "address_2": "SUITE 102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496036",
            "telephone_number": "415-883-0588",
            "fax_number": "415-883-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POKSAY",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "33831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS.",
            "identifier": "637324",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.