NPIMap

Organization Active NPI

Mary M. Jew DDS, a Professional Organization

  • Periodontics
  • Tustin, CA
National Provider Identifier
1790993913
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
35410 Issued in CA
Legal business name
MARY M. JEW DDS, A PROFESSIONAL ORGANIZATION
Practice address
18102 Irvine Blvd
Suite 200
Tustin, CA 92780-3402
Phone
(714) 838-0870
Fax
(714) 838-1033
NPI assigned
May 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary Jew
Title
President
Phone
(714) 838-0870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 35410 CA Primary

Addresses

Primary practice location

18102 Irvine Blvd
Suite 200
Tustin, CA 92780-3402

Mailing address

18102 Irvine Blvd
Suite 200
Tustin, CA 92780-3402
Phone (714) 838-0870

National Provider Directory

National Provider Directory

Locations

18102 Irvine Blvd
Ste 200
Tustin, CA 92780
Phone (714) 832-7220

NPI Registry JSON

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

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1790993913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD",
            "address_2": "SUITE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803402",
            "telephone_number": "714-838-0870",
            "fax_number": "714-838-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD",
            "address_2": "SUITE 200",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803402",
            "telephone_number": "714-838-0870",
            "fax_number": "714-838-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY M. JEW DDS, A PROFESSIONAL ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-19",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "JEW",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-838-0870",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "35410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.