Active NPI
Maxime Bachour, D.D.S.
- Endodontics
- South Pasadena, CA
National Provider Identifier
1609321199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 100739
- Practice address
- 1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995 - Phone
- (626) 685-7882
- NPI assigned
- Aug 24, 2016
- Last updated
- Sep 21, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 100739 | CA | |
| Endodontics | 1223E0200X | 100739 | CA | Primary |
Addresses
Primary practice location
1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995
Mailing address
1941 Huntington Dr Ste H
South Pasadena, CA 91030-4995
Phone (626) 658-7882
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 |
|---|---|---|---|
| 100739 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bachour Dental Corporation | Dentist | Past | Accepting new patients |
| Bachour-Lu Dental Corporation | Endodontics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba South Pasadena Endodontics
- Endodontics
- South Pasadena, CA
- NPI 1750225223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1609321199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1941 HUNTINGTON DR STE H",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910304995",
"telephone_number": "626-658-7882",
"fax_number": "626-658-7882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1941 HUNTINGTON DR STE H",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910304995",
"telephone_number": "626-685-7882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACHOUR",
"first_name": "MAXIME",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-24",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "100739",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "100739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.