Active NPI
Dominique J Medina
- Oral and Maxillofacial Surgery (Dentist)
- Torrance, CA
National Provider Identifier
1598152803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 107247
- Practice address
- 1000 W Carson St
Torrance, CA 90502-2004 - Phone
- (424) 306-4040
- NPI assigned
- Apr 24, 2015
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 107247 | CA | Primary |
Addresses
Primary practice location
1000 W Carson St
Torrance, CA 90502-2004
Mailing address
3181 SW Sam Jackson Park Road
Ohsu
Portland, OR 97239
Phone (503) 494-8211
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 |
|---|---|---|---|
| 107247 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658793600000",
"number": "1598152803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK ROAD",
"address_2": "OHSU",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-494-8211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 W CARSON ST",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905022004",
"telephone_number": "424-306-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "DOMINIQUE",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-24",
"last_updated": "2022-07-26",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "107247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.