NPIMap

Organization Active NPI

Mervat S. Bakhoum, D.D.S.

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1548439284
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
39940 Issued in CA
Legal business name
MERVAT S. BAKHOUM, D.D.S.
Practice address
443 S Soto St
Suite 100
Los Angeles, CA 90033-4315
Phone
(323) 263-6103
NPI assigned
Feb 27, 2008
Organization subpart
Yes
Parent organization
MERVAT S. BAKHOUM, D.D.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Maneesh BansalNPI 1063615102
Title
Administrator
Phone
(323) 263-6103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 39940 CA Primary

Addresses

Primary practice location

443 S Soto St
Suite 100
Los Angeles, CA 90033-4315

Mailing address

5540 N Figueroa St
Los Angeles, CA 90042-4120
Phone (323) 478-1101

Other identifiers 1

IdentifierTypeStateIssuer
G94072-01MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Mervat S Bakhoum DDS2 organizations share this tax ID, including this one
Part of
Mervat S Bakhoum DDS

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

443 S Soto St
Ste 100
Los Angeles, CA 90033
Phone (323) 263-6103

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1548439284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5540 N FIGUEROA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900424120",
            "telephone_number": "323-478-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 S SOTO ST",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900334315",
            "telephone_number": "323-263-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERVAT S. BAKHOUM, D.D.S.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERVAT S. BAKHOUM, D.D.S.",
        "enumeration_date": "2008-02-27",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "MANEESH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-263-6103"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G94072-01",
            "state": "CA"
        }
    ],
    "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 Feb 27, 2008; 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.