Active NPI
Masha Mirkin, DMD
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1689748824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 43203
- Practice address
- 4633 Ingraham Street
Suite B
San Diego, CA 92109 - Phone
- (858) 490-6999
- Fax
- (858) 490-6996
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 43203 | CA | Primary |
Addresses
Primary practice location
4633 Ingraham Street
Suite B
San Diego, CA 92109
Mailing address
4633 Ingraham Street
Suite B
San Diego, CA 92109
Phone (858) 490-6999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43203 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689748824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4633 INGRAHAM STREET",
"address_2": "SUITE B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92109",
"telephone_number": "858-490-6999",
"fax_number": "858-490-6996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4633 INGRAHAM STREET",
"address_2": "SUITE B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92109",
"telephone_number": "858-490-6999",
"fax_number": "858-490-6996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRKIN",
"first_name": "MASHA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "43203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.