NPIMap

Organization Active NPI

Simon Masood Imanuel DMD,Inc.

Doing business as Kings Family Dental Group

  • Dentist
  • Sylmar, CA
National Provider Identifier
1598835225
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
39418 Issued in CA
Legal business name
SIMON MASOOD IMANUEL DMD,INC.
Doing business as
Kings Family Dental Group
Practice address
14114 Polk St
Sylmar, CA 91342-2918
Phone
(818) 364-9444
Fax
(818) 367-6099
NPI assigned
Nov 9, 2006
Last updated
Jun 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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

Authorized official

Name
Dr. Simon Masood Imanuel, DMDNPI 1659573335
Title
President
Phone
(818) 364-9444

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
Dentist 122300000X 39418 CA Primary

Addresses

Primary practice location

14114 Polk St
Sylmar, CA 91342-2918

Mailing address

14114 Polk St
Sylmar, CA 91342-2918
Phone (818) 364-9444

Other identifiers 1

IdentifierTypeStateIssuer
G9291201MedicaidCA

Other names 1

  • Kings Family Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

14114 Polk St
Sylmar, CA 91342
Phone (818) 364-9444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1598835225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14114 POLK ST",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913422918",
            "telephone_number": "818-364-9444",
            "fax_number": "818-367-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14114 POLK ST",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913422918",
            "telephone_number": "818-364-9444",
            "fax_number": "818-367-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMON MASOOD IMANUEL DMD,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "IMANUEL",
        "authorized_official_first_name": "SIMON",
        "authorized_official_middle_name": "MASOOD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-364-9444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "39418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9291201",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Family Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylmar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; 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.