University of Southern California
Organization Active NPI General Practice Dentistry · Los Angeles, CA
NPI 1821168113 · NPPES record last updated Mar 8, 2010
Key facts
- NPI
- 1821168113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- UNIVERSITY OF SOUTHERN CALIFORNIA
- Practice address
- 925 W 34TH St
Room #151
Los Angeles, CA 90089-0641 - Phone
- (213) 740-7405
- Fax
- (213) 740-4813
- NPI assigned
- Nov 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Todd Dickey
- Title
- Senior Vice President, Administrati
- Phone
- (213) 740-8184
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 31
Practitioners 12
-
Mariela Padilla, DDS
-
Parish Paymon Sedghizadeh, DDS, MS
-
Kamal Al-Eryani Al-Eryani, DDS, PHD
-
Glen Thomas Clark, DDS
-
Jennifer E. Jones, D.D.S.
-
Joel McPhersaon, DDS
-
Mahvash Navazesh, DMD
-
Avishai Sadan, DMD
-
Tota Shimizu, DDS
-
Peter A. Stone, DDS
-
Christina Diane Wong, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Usc Kenneth Norris Jr Cancer Hospital |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 21, 2021 |
| Usc Verdugo Hills Hospital |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 21, 2021 |
| Usc Verdugo Hills Hospital |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 21, 2021 |
| Keck Hospital of Usc |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040203001147 | CA | Part B Supplier - Clinic/Group Practice | 5597658633 |
Receives reassigned benefits from 4 practitioners Practice locations: Los Angeles, CA |
| O20140916000596 | CA | DME Supplier - Oral Surgery - Dentist | 5597658633 | Practice locations: Los Angeles, CA |
National Provider Directory
- Tax ID family
- Oral Pathology Lab Usc
Locations
925 W 34th St
Rm 151
Los Angeles, CA 90089
Phone (213) 740-3410
925 W 34th St
Ste 151
Los Angeles, CA 90089
Phone (213) 740-1932
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics |
1223E0200X | |||
| General Practice Dentistry |
1223G0001X | Yes | ||
| Oral and Maxillofacial Pathology Dentistry |
1223P0106X | |||
| Pediatric Dentistry |
1223P0221X | |||
| Periodontics |
1223P0300X | |||
| Prosthodontics |
1223P0700X | |||
| Oral and Maxillofacial Surgery (Dentist) |
1223S0112X | |||
| Oral and Maxillofacial Radiology Dentistry |
1223X0008X | |||
| Orthodontics and Dentofacial Orthopedics Dentistry |
1223X0400X | |||
| Dental Hygienist |
124Q00000X | |||
| Dental Assistant |
126800000X | |||
| Dental Laboratory Technician |
126900000X |
Addresses
Primary practice location
925 W 34TH St
Room #151
Los Angeles, CA 90089-0641
Mailing address
925 W 34TH St
Room #151
Los Angeles, CA 90089-0641
Phone (213) 740-7405
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G9059502 | Other | CA | DENTICAL |
| ZZZ34010Z | Other | BLUE SIELD | |
| DC6562 | Other | CA | RAILROAD MEDICARE |
| ZZZ34010Z | Other | CA | BLUE CROSS |
| G0100701 | Other | CA | HEALTHY FAMILIES |
| 9117717 | Other | CA | UNITED CONCORDIA |
| U0100701 | Other | CA | DENTICAL |
| G0100701 | Other | CA | DENTICAL |
Other names
- USC School of Dentistry
Other providers in Los Angeles, CA
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
- University of Southern California
All providers in Los Angeles, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.