Sanjay M Mallya, B.D.S.

Primary specialty

Oral and Maxillofacial Radiology DentistryTaxonomy code 1223X0008X

License

SP-251 Issued in CA

Practice address

10833 Le Conte Ave
CHS 10-165
Los Angeles, CA 90095-1668

Phone

(310) 825-5634

Fax

(310) 206-2748

NPI assigned

Oct 18, 2005

Last updated

Mar 2, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Regents of University of California

  dba UCLA Dental Radiology Practice

  • Oral and Maxillofacial Radiology Dentistry
  • Los Angeles, CA
  • NPI 1356476865
  NPD (past) Authorized official

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267488000000",
    "number": "1538158043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 951668",
            "address_2": "CHS 10-165",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951668",
            "telephone_number": "860-679-2453",
            "fax_number": "860-679-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "CHS 10-165",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951668",
            "telephone_number": "310-825-5634",
            "fax_number": "310-206-2748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLYA",
        "first_name": "SANJAY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "B.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2010-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0008X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "CT",
            "license": "9026",
            "primary": false
        },
        {
            "code": "1223X0008X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "CA",
            "license": "SP-251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004010807",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George M. Mallouk, MD
• Jakob Harvey Mallove, MA, LMFT
• Demetria Cevonne Malloy, M.D.
• Hilary Malloy, SOCIAL WORKER (ASW)
• Michelle Kathleen Malloy, LAC
• Olga Malneva, DPT
• Danielle Maloff, L.E.P., PPS, PPS
• Andrew Rey Maloles
• Randi Malon
• Allyson Malone, MD

• Dentist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; 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.

Verify at the official NPI Registry.