Active NPI
Chanvattanak Bun
- General Practice Dentistry
- Bakersfield, CA
National Provider Identifier
1841807336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 105599
- Practice address
- 1201 24TH St
Bakersfield, CA 93301-2300 - Phone
- (714) 599-4393
- NPI assigned
- Sep 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 105599 | CA | Primary |
Addresses
Primary practice location
1201 24TH St
Bakersfield, CA 93301-2300
Mailing address
2600 Noble Ave
Bakersfield, CA 93306-2637
Phone (714) 599-4393
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105599 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1841807336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 NOBLE AVE",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933062637",
"telephone_number": "714-599-4393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 24TH ST",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933012300",
"telephone_number": "714-599-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUN",
"first_name": "CHANVATTANAK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-28",
"last_updated": "2021-01-06",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "105599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.