Individual provider Active NPI

Sukhjinder Samra, D.D.S

  • Dentist
  • Sacramento, CA
National Provider Identifier
1891053641
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
62975 Issued in CA
Practice address
4690 Natomas Blvd
Suite 100
Sacramento, CA 95835-2230
Phone
(916) 515-4500
NPI assigned
Apr 30, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 62975 CA Primary

Addresses

Primary practice location

4690 Natomas Blvd
Suite 100
Sacramento, CA 95835-2230

Mailing address

3575 Rocky Hill CT
Loomis, CA 95650-8025
Phone (916) 622-4525

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150827002614 CA Order and Referring Only - DentistPractitioner - Dentist 6002122645

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
62975CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hoang and Rho Dental Corporation Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1891053641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3575 ROCKY HILL CT",
            "city": "LOOMIS",
            "state": "CA",
            "postal_code": "956508025",
            "telephone_number": "916-622-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4690 NATOMAS BLVD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958352230",
            "telephone_number": "916-515-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMRA",
        "first_name": "SUKHJINDER",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-30",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.