Active NPI
Rohan Pathak
- Dentist
- Eastvale, CA
National Provider Identifier
1790139616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 100141
- Practice address
- 12636 Limonite Ave
Eastvale, CA 92880-4200 - Phone
- (951) 808-4323
- NPI assigned
- Apr 18, 2016
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 100141 | CA | Primary |
Addresses
Primary practice location
12636 Limonite Ave
Eastvale, CA 92880-4200
Mailing address
1361 Glenthorpe Dr
Walnut, CA 91789-3859
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 |
|---|---|---|---|
| 100141 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460937600000",
"number": "1790139616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1361 GLENTHORPE DR",
"city": "WALNUT",
"state": "CA",
"postal_code": "917893859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12636 LIMONITE AVE",
"city": "EASTVALE",
"state": "CA",
"postal_code": "928804200",
"telephone_number": "951-808-4323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATHAK",
"first_name": "ROHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-18",
"last_updated": "2016-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "100141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eastvale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.