Hansel Poerwanto, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

100447 Issued in CA

Practice address

1860 Howe Ave Ste 440
Sacramento, CA 95825-1098

Phone

(916) 569-8484

NPI assigned

Jul 26, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Practice roles

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.

• Park DDS MPH Inc

  dba Galt Dental Group

  • Dentist
  • Galt, CA
  • NPI 1801213442
  NPD (past)
• Shih-Yen Paul Hsiao, DDS MPH JD Inc

  • Dentist
  • Fresno, CA
  • NPI 1508240011
  NPD (past)

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1629521703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7194",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 HOWE AVE STE 440",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958251098",
            "telephone_number": "916-569-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POERWANTO",
        "first_name": "HANSEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-26",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alec Poe
• Andy Poe
• Carson Poe
• Jesse D Poe
• Sydney Poe
• Ilona N/a Pogany, P.T.
• Laura Poggel, M.D.
• Gwenyth Poggi, MFT
• Susan J Poggi, AMFT
• Angelika Pogodina

• Dentist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; 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.