Active NPI
Joanna Jefferson, DDS
- Dentist
- Anaheim, CA
National Provider Identifier
1871909051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63474
- Practice address
- 540 S Sunnyhill Way
Anaheim, CA 92808-1622 - Phone
- (714) 609-9356
- NPI assigned
- Jul 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 63474 | CA | Primary |
Addresses
Primary practice location
540 S Sunnyhill Way
Anaheim, CA 92808-1622
Mailing address
17875 Von Karman Ave Ste 420
Irvine, CA 92614-6273
Phone (949) 444-5656
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150724012536 | CA | Order and Referring Only - Dentist | 1456664010 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681430400000",
"number": "1871909051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17875 VON KARMAN AVE STE 420",
"city": "IRVINE",
"state": "CA",
"postal_code": "926146273",
"telephone_number": "949-444-5656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 S SUNNYHILL WAY",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928081622",
"telephone_number": "714-609-9356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "JOANNA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-08",
"last_updated": "2023-04-14",
"certification_date": "2023-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.