Larissa Gushansky, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

36156 Issued in CA

Practice address

3175 Firestone Blvd # 200
South Gate, CA 90280-2951

Phone

(323) 563-9124

Fax

(323) 563-9814

NPI assigned

May 17, 2007

Last updated

Nov 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Larissa Gushansky, DDS, Inc. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Larissa Gushansky DDS, Inc.

  • Dentist
  • South Gate, CA
  • NPI 1831383140
  NPD (past) Authorized official
• Larissa Gushansky, DDS Inc.

  • Dentist
  • Pomona, CA
  • NPI 1003000928
  Authorized official Same address or phone
• Larissa Gushansky, DDS Inc.

  • General Practice Dentistry
  • South Gate, CA
  • NPI 1154516680
  NPD (past) Authorized official

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1548478399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 GLENROY PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900492419",
            "telephone_number": "310-951-9500",
            "fax_number": "310-988-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 FIRESTONE BLVD # 200",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802951",
            "telephone_number": "323-563-9124",
            "fax_number": "323-563-9814"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 E Monterey Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917675427",
            "country_code": "US",
            "telephone_number": "909-865-8595",
            "fax_number": "909-865-7885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSHANSKY",
        "first_name": "LARISSA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "36156",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36156",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B36156-02",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B36156-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISSA",
            "last_name": "GUSHANSKY, DDS, INC.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Isaura Gutierrez, VN
• Rosalina Gutierrez
• Carlos Guzman
• Vijay Gyan, M.D.

• Dentist in South Gate, CA
• Providers in South Gate, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; 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.