NPIMap

Organization Active NPI

Eugene a Goncharov DDS Inc

  • Dentist
  • Los Angeles, CA
National Provider Identifier
1831251685
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40823 Issued in CA
Legal business name
EUGENE A GONCHAROV DDS INC
Practice address
6221 Wilshire Blvd
Ste 303
Los Angeles, CA 90048
Phone
(323) 931-2000
Fax
(323) 634-9341
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Eugene A Goncharov, DDS
Title
Owner
Phone
(323) 931-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 40823 CA Primary

Addresses

Primary practice location

6221 Wilshire Blvd
Ste 303
Los Angeles, CA 90048

Mailing address

6221 Wilshire BL
Ste 303
Los Angeles, CA 90048
Phone (323) 931-2000

Other identifiers 1

IdentifierTypeStateIssuer
040823MedicaidCA

National Provider Directory

National Provider Directory

Locations

6221 Wilshire Blvd
Ste 303
Los Angeles, CA 90048
Phone (323) 931-2000

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831251685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BL",
            "address_2": "STE 303",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "323-931-2000",
            "fax_number": "323-634-9341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 WILSHIRE BLVD",
            "address_2": "STE 303",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "323-931-2000",
            "fax_number": "323-634-9341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUGENE A GONCHAROV DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONCHAROV",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-931-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "40823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040823",
            "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 Aug 22, 2020; 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.