NPIMap

Organization Active NPI

Lifelong Medical Care

  • General Practice Dentistry
  • Berkeley, CA
National Provider Identifier
1881082329
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFELONG MEDICAL CARE
Practice address
2344 6TH St
Berkeley, CA 94710-2412
Phone
(510) 981-4122
NPI assigned
Jan 7, 2015
Last updated
Jan 7, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFELONG MEDICAL CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Mr. Martin Lynch, PHD
Title
Chief Executive Officer
Phone
(510) 981-4123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2344 6TH St
Berkeley, CA 94710-2412

Mailing address

PO Box 11247
Berkeley, CA 94712-2247
Phone (510) 981-4122

Other names 1

  • LifeLong Dental Van Other name

National Provider Directory

National Provider Directory
Tax ID family
Lifelong Jenkins Pediatric Center44 organizations share this tax ID, including this one
Part of
Lifelong Jenkins Pediatric Center

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Practitioners & affiliated clinicians

Practitioners 1

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": "1420588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1881082329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11247",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947122247",
            "telephone_number": "510-981-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2344 6TH ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947102412",
            "telephone_number": "510-981-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFELONG MEDICAL CARE",
        "enumeration_date": "2015-01-07",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-981-4123",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeLong Dental Van",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.