NPIMap

Organization Active NPI

Ellen Im DDS Inc

Doing business as Dr. Ellen Im Pediatric Dentistry and Orthodontics

  • Pediatric Dentistry
  • Poway, CA
National Provider Identifier
1861091720
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ELLEN IM DDS INC
Doing business as
Dr. Ellen Im Pediatric Dentistry and Orthodontics
Practice address
13422 Pomerado Rd Ste 201
Poway, CA 92064-3548
Phone
(858) 679-6660
NPI assigned
Oct 21, 2020
Last updated
May 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Authorized official

Name
Dr. Ellen Im, DDSNPI 1023029220
Title
Owner/Operator
Phone
(858) 679-6660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

13422 Pomerado Rd Ste 201
Poway, CA 92064-3548

Mailing address

13422 Pomerado Rd Ste 201
Poway, CA 92064-3548

Other names 1

  • Dr. Ellen Im Pediatric Dentistry and Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

13422 Pomerado Rd
Ste 201
Poway, CA 92064
Phone (858) 679-6660

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1861091720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13422 POMERADO RD STE 201",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920643548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13422 POMERADO RD STE 201",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920643548",
            "telephone_number": "858-679-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN IM DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-21",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "IM",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "858-679-6660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Ellen Im Pediatric Dentistry and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poway, CA

Sources for this page

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

Verify at the official NPI Registry.