Ray Derakshan, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

46044 Issued in CA

Practice address

11134 Rancho Carmel Dr
Suite 103
San Diego, CA 92128-4671

Phone

(858) 485-1010

Fax

(858) 485-1116

NPI assigned

Feb 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ray Derakshan, DMD Inc

  • Preferred Provider Organization
  • San Diego, CA
  • NPI 1255579793
  NPD (past) Authorized official

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770621591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11134 RANCHO CARMEL DR",
            "address_2": "SUITE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921284671",
            "telephone_number": "858-485-1010",
            "fax_number": "858-485-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11134 RANCHO CARMEL DR",
            "address_2": "SUITE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921284671",
            "telephone_number": "858-485-1010",
            "fax_number": "858-485-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAKSHAN",
        "first_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Depth Marriage and Family Therapy, Professional Corporation (Depth Psychotherapy San Diego)
• Kelsey Lynn Deputy, AU.D.
• Eden Depuydt
• Kiara Der
• Maryam Derakhshani
• Bayron Deraz Rivera
• Emily Jacobs Derby
• Pauline Ann Derdzinska, LVN
• Jessica Ann Deree, M.D.
• Timothy James Derego, FNP-C

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, 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 Jul 8, 2007; 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.