Corinna Chelsea Ma, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105494 Issued in CA

Practice address

1042 Pacific St Ste B
San Luis Obispo, CA 93401-3661

Phone

(805) 543-6963

NPI assigned

Aug 16, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• C F Wong Beta Dental Incorporated

  • Dental Clinic/Center
  • San Luis Obispo, CA
  • NPI 1225527765
  NPD (past)
• Lee F. Hollister,DDS Jon E. Hollisterdds Dental Corporation

  • General Practice Dentistry
  • San Luis Obispo, CA
  • NPI 1962609529
  NPD (past)

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1821644667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "864 BOUGAINVILLEA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017609",
            "telephone_number": "530-379-9390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 PACIFIC ST STE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013661",
            "telephone_number": "805-543-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "CORINNA",
        "middle_name": "CHELSEA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smiles@tualatinmoderndentistry.com",
            "affiliation": "N",
            "address_1": "7017 SW Nyberg St Ste P-46",
            "city": "Tualatin",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970626243",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "1042magnoliadental@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "1042 Pacific St Ste B",
            "city": "San Luis Obispo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "934013661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle Lynn Lynch
• Deborah Lee Lyon, DDS MFT INTERN
• Kristopher Lyon, M.D.
• Nicole Joanne Lyons
• M K Larson Audiology Inc
• Kristine Maas, OTR/L
• Somer Michelle Maas
• John A Macari, L.P.T.
• Toni Macclain, NP
• Hillary L Maccready

• General Practice Dentistry in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.