Individual provider Active NPI

Thomas S Tanbonliong, D.D.S.

  • Pediatric Dentistry
  • Los Angeles, CA
National Provider Identifier
1689886624
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
42618 Issued in CA
Practice address
411 N Larchmont Blvd
Los Angeles, CA 90004-3013
Phone
(323) 304-5763
NPI assigned
May 3, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 42618 CA Primary

Addresses

Primary practice location

411 N Larchmont Blvd
Los Angeles, CA 90004-3013

Mailing address

411 N Larchmont Blvd
Los Angeles, CA 90004-3013
Phone (323) 304-5763

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200825000471 CA Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 7618394594 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco CurrentSince Aug 27, 2020 Accepting new patients
UCSF Medical Group Business Services CurrentSince Aug 27, 2020 Accepting new patients
UCSF Oral Medicine Clinic CurrentSince Aug 27, 2020 Accepting new patients
UCSF Medical Group Business Services CurrentSince Aug 27, 2020 Accepting new patients
University of California San Francisco CurrentSince Aug 27, 2020 Accepting new patients
UCSF Oral & Maxillofacial Surgery CurrentSince Aug 27, 2020 Accepting new patients
University of California San Francisco Current Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients
University of California San Francisco Past Accepting new patients

Locations

4881 Telegraph Ave
Oakland, CA 94609
Phone (510) 428-3316

1975 4th St
San Francisco, CA 94143
Phone (415) 353-3000

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

513 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-1239

513 Parnassus Ave
Rm S722
San Francisco, CA 94143
Phone (415) 476-2045

707 Parnassus Ave
Fl 1
San Francisco, CA 94143

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689886624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043013",
            "telephone_number": "323-304-5763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043013",
            "telephone_number": "323-304-5763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANBONLIONG",
        "first_name": "THOMAS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "42618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.