Active NPI
Loc Bao, D.D.S.
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1770750424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 44290
- Practice address
- 4236 El Cajon Blvd
San Diego, CA 92105-1230 - Phone
- (619) 584-4015
- Fax
- (619) 584-4016
- NPI assigned
- May 13, 2008
- Last updated
- May 13, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 44290 | CA | Primary |
Addresses
Primary practice location
4236 El Cajon Blvd
San Diego, CA 92105-1230
Mailing address
4236 El Cajon Blvd
San Diego, CA 92105-1230
Phone (619) 584-4015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D44290 | Other | CA | DENTI-CAL |
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 |
|---|---|---|---|
| 44290 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loc Bao, DDS, Inc. | General Practice | Past | Accepting new patients |
| Ken Dental Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- San Diego, CA
- NPI 1528138039
-
- General Practice Dentistry
- San Diego, CA
- NPI 1730653437
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1770750424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4236 EL CAJON BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051230",
"telephone_number": "619-584-4015",
"fax_number": "619-584-4016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4236 EL CAJON BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051230",
"telephone_number": "619-584-4015",
"fax_number": "619-584-4016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAO",
"first_name": "LOC",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-13",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "44290",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL",
"identifier": "D44290",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.