Individual provider Active NPI

Suramya Sharma

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1750145579
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
109860 Issued in CA
Practice address
11653 Westview Pkwy
San Diego, CA 92126-5500
Phone
(480) 669-0594
NPI assigned
Feb 12, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109860 CA
General Practice Dentistry 1223G0001X 109860 CA Primary

Addresses

Primary practice location

11653 Westview Pkwy
San Diego, CA 92126-5500

Mailing address

11653 Westview Pkwy
San Diego, CA 92126-5500
Phone (480) 669-0594

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240824000277 CA Order and Referring Only - DentistPractitioner - Dentist 2466991278

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1750145579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11653 WESTVIEW PKWY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921265500",
            "telephone_number": "480-669-0594",
            "fax_number": "480-669-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11653 WESTVIEW PKWY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921265500",
            "telephone_number": "480-669-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARMA",
        "first_name": "SURAMYA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109860",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.