NPIMap

Organization Active NPI

Rady Children's Health Services-San Diego

Doing business as San Diego Children's Health Services

  • Dental Clinic/Center
  • San Diego, CA
National Provider Identifier
1649369653
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
RADY CHILDREN'S HEALTH SERVICES-SAN DIEGO
Doing business as
San Diego Children's Health Services
Practice address
3020 Childrens Way
Mailcode 5127
San Diego, CA 92123-4223
Phone
(858) 576-1700
Fax
(858) 966-8097
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Tiffany Lynn Kavanaugh
Title
Office Manager
Phone
(858) 966-5802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X CA Primary

Addresses

Primary practice location

3020 Childrens Way
Mailcode 5127
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way
Mailcode 5127
San Diego, CA 92123-4223
Phone (858) 576-1700

Other identifiers 2

IdentifierTypeStateIssuer
G98449-01OtherCAHEALTHY FAMILY STATE PROG
G93636-01MedicaidCA

Other names 1

  • San Diego Children's Health Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Rady Children's Health Services-San Diego3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3020 Childrens Way
#5127
San Diego, CA 92123
Phone (858) 966-4094

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649369653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "address_2": "MAILCODE 5127",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-576-1700",
            "fax_number": "858-966-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "address_2": "MAILCODE 5127",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-576-1700",
            "fax_number": "858-966-8097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADY CHILDREN'S HEALTH SERVICES-SAN DIEGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAVANAUGH",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "858-966-5802",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILY STATE PROG",
            "identifier": "G98449-01",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G93636-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego Children's Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.