Timothy Leetrakul DDS Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

58017 Issued in CA

Legal business name

TIMOTHY LEETRAKUL DDS DENTAL CORPORATION

Practice address

12643 Sherman Way Ste D
North Hollywood, CA 91605-5271

Phone

(818) 765-3534

Fax

(818) 765-3537

NPI assigned

Sep 22, 2014

Organization subpart

No

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

Authorized official

Name

Timothy Leetrakul, DDSNPI 1932343647

Title

President

Phone

(818) 765-3534

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Timothy Leetrakul

  • Dentist
  • North Hollywood, CA
  • NPI 1932343647
  NPD Authorized official

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1699177642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12643 SHERMAN WAY STE D",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916055271",
            "telephone_number": "818-765-3534",
            "fax_number": "818-765-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12643 SHERMAN WAY STE D",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916055271",
            "telephone_number": "818-765-3534",
            "fax_number": "818-765-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY LEETRAKUL DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "LEETRAKUL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-765-3534",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.