Active NPI
Ryan Mak
- General Practice Dentistry
- Rocklin, CA
National Provider Identifier
1669959391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS102798
- Practice address
- 3291 Stanford Ranch Rd Ste 102
Rocklin, CA 95765-5577 - Phone
- (916) 505-5737
- NPI assigned
- Jul 25, 2018
- 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 | DDS102798 | CA | Primary |
Addresses
Primary practice location
3291 Stanford Ranch Rd Ste 102
Rocklin, CA 95765-5577
Mailing address
3291 Stanford Ranch Rd Ste 102
Rocklin, CA 95765-5577
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181105003455 | CA | Order and Referring Only - Dentist | 0941553101 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102798 | CA | MD | Mental Health Counselor |
| DDS102798 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1669959391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3291 STANFORD RANCH RD STE 102",
"city": "ROCKLIN",
"state": "CA",
"postal_code": "957655577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3291 STANFORD RANCH RD STE 102",
"city": "ROCKLIN",
"state": "CA",
"postal_code": "957655577",
"telephone_number": "916-505-5737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAK",
"first_name": "RYAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-07-25",
"last_updated": "2018-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DDS102798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocklin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.