Pavithra Shetty Thankachen, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51522 Issued in CA

Practice address

2131 East Coast Hwy Suite 220
Corona del Mar, CA 92625-3421

Phone

(949) 644-1001

NPI assigned

Aug 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Dr. Pavithra G Shetty Former name

Electronic endpoints 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Sanjai Thankachen PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Huntington Beach, CA
  • NPI 1679003834
  NPD (past)

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1720196173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 EAST COAST HWY SUITE 220",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926253421",
            "telephone_number": "949-644-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 EAST COAST HWY SUITE 220",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926253421",
            "telephone_number": "949-644-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 Sunrise Hwy",
            "address_purpose": "LOCATION",
            "city": "Bay Shore",
            "state": "NY",
            "postal_code": "117066091",
            "country_code": "US",
            "telephone_number": "631-666-1441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THANKACHEN",
        "first_name": "PAVITHRA",
        "middle_name": "SHETTY",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-27",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "51522",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0518561",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51522",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "psthank@gmail.com",
            "affiliation": "N",
            "address_1": "2131 East Coast HWY Suite 220",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926253421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PAVITHRA",
            "last_name": "SHETTY",
            "middle_name": "G",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in Corona del Mar, CA
• Providers in Corona del Mar, 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 Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.