Devin Dejon Ellis, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62642 Issued in CA

Practice address

5555 Del Amo Blvd
Lakewood, CA 90713-2307

Phone

(562) 866-1735

NPI assigned

Aug 26, 2013

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

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

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.

• Robert Goodis DDS and Nate Weiner DDS

  • Dentist
  • Lakewood, CA
  • NPI 1790999340
  NPD (past)
• Rozekoria, Inc.

  • Dentist
  • Newport Beach, CA
  • NPI 1760697445
  NPD (past)

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

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1750715843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 DEL AMO BLVD",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907132307",
            "telephone_number": "562-866-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 DEL AMO BLVD",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907132307",
            "telephone_number": "562-866-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DEVIN",
        "middle_name": "DEJON",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-26",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ehab Samaan DDS,Inc
• Isaac Eisenstein, M.D.
• Maranina Mary Eister
• Roy Allan O Elevazo, PMHNP-BC
• Anna Teresa Macalalad Eliseo, RN
• Empire Wellness Mental Health Group
• Empire Wellness, LLC
• End of Shift Management Group Inc
• Brianna Engel
• Enola Jamora Chiropractic, Inc.

• General Practice Dentistry in Lakewood, CA
• Providers in Lakewood, 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 Nov 1, 2016; 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.