Individual provider Active NPI

Peter Chen

  • General Practice Dentistry
  • Santa Ana, CA
National Provider Identifier
1841336898
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
47460 Issued in CA
Practice address
2144 S Bristol St
Santa Ana, CA 92704-5123
Phone
(714) 784-5779
Fax
(323) 249-7565
NPI assigned
Jan 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 47460 CA Primary

Addresses

Primary practice location

2144 S Bristol St
Santa Ana, CA 92704-5123

Mailing address

2144 S Bristol St
Santa Ana, CA 92704-5123
Phone (714) 784-5779

Other identifiers 1

IdentifierTypeStateIssuer
D47460MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160105002660 CA Order and Referring Only - DentistPractitioner - Dentist 4789986910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
47460CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Scott Jacks, DDS, Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1841336898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 S BRISTOL ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045123",
            "telephone_number": "714-784-5779",
            "fax_number": "323-249-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 S BRISTOL ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045123",
            "telephone_number": "714-784-5779",
            "fax_number": "323-249-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D47460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.