Individual provider Active NPI

Erica Hsiao, DDS

  • Dentist
  • Roseville, CA
National Provider Identifier
1609216332
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63898 Issued in CA
Practice address
2110 Professional Dr Ste 115
Roseville, CA 95661-3778
Phone
(602) 751-6402
Fax
(916) 783-5614
NPI assigned
Jun 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019029270 IL
Dentist 122300000X 63898 CA Primary

Addresses

Primary practice location

2110 Professional Dr Ste 115
Roseville, CA 95661-3778

Mailing address

2110 Professional Dr Ste 115
Roseville, CA 95661-3778
Phone (602) 751-6402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141002002295 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4880814409

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63898CAMDDentist
019029270ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Okhovat Professional Dental PastSince Aug 28, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1609216332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 PROFESSIONAL DR STE 115",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613778",
            "telephone_number": "602-751-6402",
            "fax_number": "916-783-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 PROFESSIONAL DR STE 115",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613778",
            "telephone_number": "602-751-6402",
            "fax_number": "916-783-5614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HSIAO",
        "first_name": "ERICA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029270",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.