Active NPI
Peter Robertson Sumarsono, D.D.S
- General Practice Dentistry
- Irvine, CA
National Provider Identifier
1568617587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 40736
- Practice address
- 62 Corporate Park
Barranca Medical Plaza, Suite 200
Irvine, CA 92606 - Phone
- (714) 864-8261
- Fax
- (714) 572-0572
- NPI assigned
- Nov 18, 2008
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 40736 | CA | Primary |
Addresses
Primary practice location
62 Corporate Park
Barranca Medical Plaza, Suite 200
Irvine, CA 92606
Mailing address
17092 Vista Moraga
Yorba Linda, CA 92886-6209
Phone (714) 864-8261
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40736 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1568617587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17092 VISTA MORAGA",
"city": "YORBA LINDA",
"state": "CA",
"postal_code": "928866209",
"telephone_number": "714-864-8261",
"fax_number": "714-572-0572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 CORPORATE PARK",
"address_2": "BARRANCA MEDICAL PLAZA, SUITE 200",
"city": "IRVINE",
"state": "CA",
"postal_code": "92606",
"telephone_number": "714-864-8261",
"fax_number": "714-572-0572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMARSONO",
"first_name": "PETER",
"middle_name": "ROBERTSON",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-18",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "40736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.