NPIMap

Organization Active NPI

Ryan W. Jergensen, DDS, Professional Corporation

  • Dentist
  • Fremont, CA
National Provider Identifier
1649559758
Registry record updated Aug 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
59484 Issued in CA
Legal business name
RYAN W. JERGENSEN, DDS, PROFESSIONAL CORPORATION
Practice address
2243 Mowry Ave Ste B
Fremont, CA 94538-1630
Phone
(510) 797-8991
Fax
(510) 797-8280
NPI assigned
Aug 6, 2011
Last updated
Aug 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2011

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

Authorized official

Name
Dr. Ryan W. Jergensen, DDSNPI 1376859124
Title
President
Phone
(510) 797-8991

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 59484 CA Primary

Addresses

Primary practice location

2243 Mowry Ave Ste B
Fremont, CA 94538-1630

Mailing address

2243 Mowry Ave Ste B
Fremont, CA 94538-1630
Phone (510) 797-8991

Other identifiers 1

IdentifierTypeStateIssuer
1376859124OtherCAPERSONAL/TYPE I NPI

National Provider Directory

National Provider Directory

Locations

2243 Mowry Ave
Ste B
Fremont, CA 94538
Phone (510) 797-8991

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1312588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312588800000",
    "number": "1649559758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2243 MOWRY AVE STE B",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381630",
            "telephone_number": "510-797-8991",
            "fax_number": "510-797-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2243 MOWRY AVE STE B",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381630",
            "telephone_number": "510-797-8991",
            "fax_number": "510-797-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN W. JERGENSEN, DDS, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-06",
        "last_updated": "2011-08-06",
        "status": "A",
        "authorized_official_last_name": "JERGENSEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-797-8991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "59484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL/TYPE I NPI",
            "identifier": "1376859124",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.

Verify at the official NPI Registry.