Active NPI
Sooho Joe, D.D.S.
- General Practice Dentistry
- Coachella, CA
National Provider Identifier
1629294608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 48473
- Practice address
- 51807 Harrison St Ste 102-103
Coachella, CA 92236-1524 - Phone
- (760) 398-9288
- Fax
- (760) 398-9215
- NPI assigned
- Apr 18, 2007
- 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 | 48473 | CA | Primary |
Addresses
Primary practice location
51807 Harrison St Ste 102-103
Coachella, CA 92236-1524
Mailing address
51807 Harrison St Ste 102-103
Coachella, CA 92236-1524
Phone (760) 398-9288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 48473 | Other | CA | DENTICAL RENDERING # |
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 |
|---|---|---|---|
| 48473 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sooho Joe,DDS,Inc | General Practice | Past | 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": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367020800000",
"number": "1629294608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51807 HARRISON ST STE 102-103",
"city": "COACHELLA",
"state": "CA",
"postal_code": "922361524",
"telephone_number": "760-398-9288",
"fax_number": "760-398-9215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51807 HARRISON ST STE 102-103",
"city": "COACHELLA",
"state": "CA",
"postal_code": "922361524",
"telephone_number": "760-398-9288",
"fax_number": "760-398-9215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOE",
"first_name": "SOOHO",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-18",
"last_updated": "2013-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "48473",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL RENDERING #",
"identifier": "48473",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coachella, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.