Active NPI
Tiklat Issa, D.D.S.
- Dentist
- Long Beach, CA
National Provider Identifier
1790217669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 101254
- Practice address
- 4440 E Village Rd
Long Beach, CA 90808-1540 - Phone
- (562) 425-3311
- NPI assigned
- Mar 30, 2017
- 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 | 101254 | CA | Primary |
Addresses
Primary practice location
4440 E Village Rd
Long Beach, CA 90808-1540
Mailing address
4440 E Village Rd
Long Beach, CA 90808-1540
Phone (166) 164-5840
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 |
|---|---|---|---|
| 101254 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tiklat Issa DDS Corp | Dentist | Current | Accepting new patients |
| Issa Dental Corporation | Current | Accepting new patients | |
| Issa Dental Corporation | Dentist | Current | Accepting new patients |
Locations
4440 E Village Rd
Long Beach, CA 90808
Phone (562) 425-3311
Organizations & group practices 3
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.
-
- Dentist
- Long Beach, CA
- NPI 1134963325
-
- General Practice Dentistry
- Long Beach, CA
- NPI 1790421725
-
- Dentist
- Huntington Beach, CA
- NPI 1952191405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652227200000",
"number": "1790217669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4440 E VILLAGE RD",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081540",
"telephone_number": "166-164-5840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4440 E VILLAGE RD",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081540",
"telephone_number": "562-425-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISSA",
"first_name": "TIKLAT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-30",
"last_updated": "2022-05-11",
"certification_date": "2022-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "101254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.