Justin Srithongrung, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS101888 Issued in CA

Practice address

2030 S Baldwin Ave
Arcadia, CA 91007-8155

Phone

(626) 551-8355

NPI assigned

Mar 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1629430442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 S BALDWIN AVE",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910078155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 S BALDWIN AVE",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910078155",
            "telephone_number": "626-551-8355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "290 N Wayte Ln Ste 2500",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937012124",
            "country_code": "US",
            "telephone_number": "559-459-5725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SRITHONGRUNG",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS101888",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS101888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allan Spencer
• Pennie Spirtos, PT, DPT
• Inna Ella Spivak, N.P.
• Poorna Sreekumar, MD
• Sowmya Srinivas
• St. Jude Hospital Yorba Linda
• St. Vincent Hospice and Palliative Care Services Inc
• Benjamin Thomas Stafford, M.D.
• Greg S. Stanford, PSY.D.
• Stanley J Alexander MD Inc

• General Practice Dentistry in Arcadia, CA
• Providers in Arcadia, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.