Active NPI
Bruce David Janzen
- Dentist
- Desert Hot Springs, CA
National Provider Identifier
1750512174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- #39422
- Practice address
- 11750 Cholla Dr Ste B
Desert Hot Springs, CA 92240-3064 - Phone
- (760) 251-0044
- NPI assigned
- Aug 3, 2009
- Sex
- Male
- 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 | #39422 | CA | Primary |
Addresses
Primary practice location
11750 Cholla Dr Ste B
Desert Hot Springs, CA 92240-3064
Mailing address
12190 2ND Street
Yucaipa, CA 92399
Phone (909) 797-9099
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160525003007 | CA | Order and Referring Only - Dentist | 2264722669 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #39422 | CA | MD | Dentist |
| 39422 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435017600000",
"number": "1750512174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12190 2ND STREET",
"city": "YUCAIPA",
"state": "CA",
"postal_code": "92399",
"telephone_number": "909-797-9099",
"fax_number": "909-797-7794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11750 CHOLLA DR STE B",
"city": "DESERT HOT SPRINGS",
"state": "CA",
"postal_code": "922403064",
"telephone_number": "760-251-0044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANZEN",
"first_name": "BRUCE",
"middle_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-03",
"last_updated": "2015-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "#39422",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desert Hot Springs, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.