Active NPI
Shan Qian
- Dentist
- Eastvale, CA
National Provider Identifier
1891529327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 110639
- Practice address
- 13334 Limonite Ave Ste 120
Eastvale, CA 92880-7257 - Phone
- (951) 228-9294
- NPI assigned
- Aug 28, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 110639 | CA | Primary |
Addresses
Primary practice location
13334 Limonite Ave Ste 120
Eastvale, CA 92880-7257
Mailing address
15920 Pomona Rincon Rd Unit 7802
Chino Hills, CA 91709-5543
Phone (949) 537-6723
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 |
|---|---|---|---|---|
| I20250923003990 | CA | Order and Referring Only - Dentist | 9234634031 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110639 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yen and Dimitri Dental Corporation | Dentist | 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.
-
- Dentist
- Eastvale, CA
- NPI 1114441193
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1891529327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15920 POMONA RINCON RD UNIT 7802",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917095543",
"telephone_number": "949-537-6723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13334 LIMONITE AVE STE 120",
"city": "EASTVALE",
"state": "CA",
"postal_code": "928807257",
"telephone_number": "951-228-9294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QIAN",
"first_name": "SHAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-28",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "110639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eastvale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.