NPIMap

Organization Active NPI

Farwest Dental Group

  • Dentist
  • Wilmington, CA
National Provider Identifier
1699200220
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
52604 Issued in CA
Legal business name
FARWEST DENTAL GROUP
Practice address
1704 N Avalon Blvd
Wilmington, CA 90744-1433
Phone
(310) 835-5130
Fax
(310) 835-6090
NPI assigned
Apr 20, 2017
Last updated
Apr 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Authorized official

Name
Dr. Hassan Fayoumi, DDSNPI 1831269489
Title
Onwer
Phone
(310) 699-1549

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 52604 CA Primary

Addresses

Primary practice location

1704 N Avalon Blvd
Wilmington, CA 90744-1433

Mailing address

1704 N Avalon Blvd
Wilmington, CA 90744-1433
Phone (310) 835-5130

National Provider Directory

National Provider Directory
Tax ID family
Farwest Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1704 N Avalon Blvd
Wilmington, CA 90744
Phone (310) 835-5030

Practitioners & affiliated clinicians

Practitioners 1

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": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1699200220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441433",
            "telephone_number": "310-835-5130",
            "fax_number": "310-835-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441433",
            "telephone_number": "310-835-5130",
            "fax_number": "310-835-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARWEST DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "FAYOUMI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "310-699-1549",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "52604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.