Derek L Vajda, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

65363 Issued in CA

Practice address

1541 Centinela Ave Apt 105
Santa Monica, CA 90404-3222

Phone

(219) 789-8308

NPI assigned

May 31, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 2, 2021 through Aug 2, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: dvajda380606@direct.uclahealth.org

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.

• Derek L Vajda DDS MD Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Alhambra, CA
  • NPI 1760050736
  NPD Authorized official
• Regents of the University of California

  • Podiatrist
  • Los Angeles, CA
  • NPI 1750723540

  Dentist

  NPD (past)
• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248
  NPD (past)

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1548618648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 CENTINELA AVE APT 105",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904043222",
            "telephone_number": "219-789-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 CENTINELA AVE APT 105",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904043222",
            "telephone_number": "219-789-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAJDA",
        "first_name": "DEREK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-31",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD5450",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "65363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl Devlin Utsinger, MD
• Rocio Vaca, LCSW
• Jared Spencer Vagy, PT
• Arpita Anil Vaidya, DPT
• Reuben Vaisman-Tzachor, PH.D.
• Val Burton Hearing AIDS, Inc.
• Val C Burton D C a Chiropractic Corp
• Garyn M Valdemar, LCSW
• Yunuen Valencia, PPS
• Ana Valenzuela

• Oral and Maxillofacial Surgery (Dentist) in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.