Active NPI
Henry Phillips, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1790842672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 49394
- Practice address
- 1110 N Western Ave
Suite # 205
Los Angeles, CA 90029-1088 - Phone
- (323) 476-2114
- NPI assigned
- Jan 2, 2007
- 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 | 49394 | CA | Primary |
Addresses
Primary practice location
1110 N Western Ave
Suite # 205
Los Angeles, CA 90029-1088
Mailing address
4712 Admiralty Way # 461
Marina del Rey, CA 90292-6905
Phone (310) 733-7150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D49394 | Medicaid | CA |
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 |
|---|---|---|---|
| 49394 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389571200000",
"number": "1790842672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4712 ADMIRALTY WAY # 461",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902926905",
"telephone_number": "310-733-7150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 N WESTERN AVE",
"address_2": "SUITE # 205",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900291088",
"telephone_number": "323-476-2114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "HENRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2014-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "49394",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D49394",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.