Modesto Luis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36401 Issued in CA

Practice address

4444 Tweedy Blvd
South Gate, CA 90280-6304

Phone

(323) 564-2444

Fax

(323) 249-7565

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1720134091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5238 LOS CABALLEROS WAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900271012",
            "fax_number": "323-249-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806304",
            "telephone_number": "323-564-2444",
            "fax_number": "323-249-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUIS",
        "first_name": "MODESTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D36401",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stanley Lowe, D.P.M.
• Loyola Family Health Center Professional Corporation
• Loyola Medical Center a Professional Corporation
• Loyola Wellness Center
• Luis Moran DDS a Dental Corporation
• Lulu L. Chen, MD Inc.
• Jay Lutsky, DMD
• M Zarrabi Medical Corporation
• M. Noori, DDS, Inc.
• Sergio Machado Sr.

• General Practice Dentistry in South Gate, CA
• Providers in South Gate, 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 Jul 9, 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.

Verify at the official NPI Registry.