Active NPI
Lita Hermansjah, DDS
- Dentist
- Corona, CA
National Provider Identifier
1740367440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 47904
- Practice address
- 916 West Sixth Street
Corona, CA 92882-3239 - Phone
- (951) 738-1749
- Fax
- (951) 738-1760
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 47904 | CA | Primary |
Addresses
Primary practice location
916 West Sixth Street
Corona, CA 92882-3239
Mailing address
PO Box 2769
Corona, CA 92878-2769
Phone (951) 738-1749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47904 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461024000000",
"number": "1740367440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2769",
"city": "CORONA",
"state": "CA",
"postal_code": "928782769",
"telephone_number": "951-738-1749",
"fax_number": "951-738-1760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 WEST SIXTH STREET",
"city": "CORONA",
"state": "CA",
"postal_code": "928823239",
"telephone_number": "951-738-1749",
"fax_number": "951-738-1760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMANSJAH",
"first_name": "LITA",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2016-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "47904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.