Active NPI
P Mark Portnoy, DMD
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1609946482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27353
- Practice address
- 8240 Beverly Blvd
#9
Los Angeles, CA 90048-4529 - Phone
- (323) 658-6970
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 27353 | CA | Primary |
Addresses
Primary practice location
8240 Beverly Blvd
#9
Los Angeles, CA 90048-4529
Mailing address
8240 Beverly Blvd
#9
Los Angeles, CA 90048-4529
Phone (323) 658-6970
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27353 | Other | CA | DENTAL LICENSE |
| 95-3912311 | Other | TAX ID |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1609946482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8240 BEVERLY BLVD",
"address_2": "#9",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484529",
"telephone_number": "323-658-6970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8240 BEVERLY BLVD",
"address_2": "#9",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484529",
"telephone_number": "323-658-6970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTNOY",
"first_name": "P",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "27353",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "27353",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "95-3912311",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.