Active NPI
Harley Bishop Grandin, DDS
- Endodontics
- Oakland, CA
National Provider Identifier
1851831622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 103151
- Practice address
- 9359 Skyline Blvd
Oakland, CA 94611-1751 - Phone
- (415) 317-7331
- NPI assigned
- Feb 27, 2017
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | 018002110 | IL | |
| Endodontics | 1223E0200X | 103151 | CA | Primary |
Addresses
Primary practice location
9359 Skyline Blvd
Oakland, CA 94611-1751
Mailing address
9359 Skyline Blvd
Oakland, CA 94611-1751
Phone (415) 317-7331
Other practice location 1
1435 W 15th St Apt 407
Chicago, IL 60608
Phone (415) 317-7331
Other practice location 2
18 Southdale Ave
Daly City, CA 94015-4238
Phone (415) 317-7331
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 |
|---|---|---|---|
| 103151 | CA | MD | Endodontist |
| 018002110 | IL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649289600000",
"number": "1851831622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9359 SKYLINE BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946111751",
"telephone_number": "415-317-7331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9359 SKYLINE BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946111751",
"telephone_number": "415-317-7331"
}
],
"practiceLocations": [
{
"address_1": "1435 W 15th St Apt 407",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "60608",
"country_code": "US",
"telephone_number": "415-317-7331",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18 Southdale Ave",
"address_purpose": "LOCATION",
"city": "Daly City",
"state": "CA",
"postal_code": "940154238",
"country_code": "US",
"telephone_number": "415-317-7331",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRANDIN",
"first_name": "HARLEY",
"middle_name": "BISHOP",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-27",
"last_updated": "2022-04-07",
"certification_date": "2022-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "018002110",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "103151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.