Individual provider Active NPI

Mihai Kiss, D.D.S.

  • General Practice Dentistry
  • Tustin, CA
National Provider Identifier
1700334265
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
100857 Issued in CA
Practice address
18102 Irvine Blvd
Suite #201
Tustin, CA 92780-3402
Phone
(714) 767-6970
NPI assigned
Sep 13, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 100857 CA Primary

Addresses

Primary practice location

18102 Irvine Blvd
Suite #201
Tustin, CA 92780-3402

Mailing address

18102 Irvine Blvd
Suite #201
Tustin, CA 92780-3402
Phone (714) 767-6970

Other practice location 1

1931 Main St
Green Bay, WI 54302-3920
Phone (920) 499-2770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170323002072 WI Order and Referring Only - DentistPractitioner - Dentist 2365727831

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100857CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mihai Kiss DDS Inc. General Practice Current Accepting new patients
Familia Dental Green Bay East LLC General Practice PastSince Jun 27, 2021 Accepting new patients

Locations

18102 Irvine Blvd
Ste 201
Tustin, CA 92780
Phone (714) 730-9656

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1700334265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD",
            "address_2": "SUITE #201",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803402",
            "telephone_number": "714-767-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD",
            "address_2": "SUITE #201",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803402",
            "telephone_number": "714-767-6970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1931 Main St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543023920",
            "country_code": "US",
            "telephone_number": "920-499-2770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISS",
        "first_name": "MIHAI",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-13",
        "last_updated": "2021-08-12",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "100857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.