Active NPI
Justin Shoryu Ogawa, DMD
- Dentist
- Los Angeles, CA
National Provider Identifier
1528786795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 107770
- Practice address
- 1530 S Olive St
Los Angeles, CA 90015-3023 - Phone
- (213) 747-5542
- NPI assigned
- Aug 15, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 107770 | CA | Primary |
Addresses
Primary practice location
1530 S Olive St
Los Angeles, CA 90015-3023
Mailing address
23295 Coffee Berry Cir
Corona, CA 92883-8134
Phone (678) 670-3533
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 |
|---|---|---|---|---|
| I20220830004121 | CA | Order and Referring Only - Dentist | 3779967328 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107770 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1528786795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23295 COFFEE BERRY CIR",
"city": "CORONA",
"state": "CA",
"postal_code": "928838134",
"telephone_number": "678-670-3533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1530 S OLIVE ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900153023",
"telephone_number": "213-747-5542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OGAWA",
"first_name": "JUSTIN",
"middle_name": "SHORYU",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-15",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "107770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.