Individual provider Active NPI

Christopher Basiago, D.D.S.

  • General Practice Dentistry
  • Long Beach, CA
National Provider Identifier
1912089830
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
032268 Issued in CA
Practice address
5373 E Village Rd
Suite C
Long Beach, CA 90808-1600
Phone
(562) 429-5965
Fax
(562) 429-7318
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 032268 CA Primary

Addresses

Primary practice location

5373 E Village Rd
Suite C
Long Beach, CA 90808-1600

Mailing address

5373 E Village Rd
Suite C
Long Beach, CA 90808-1600
Phone (562) 429-5965

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
I20141107002054 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8325260201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
032268CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912089830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5373 E VILLAGE RD",
            "address_2": "SUITE C",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081600",
            "telephone_number": "562-429-5965",
            "fax_number": "562-429-7318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5373 E VILLAGE RD",
            "address_2": "SUITE C",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081600",
            "telephone_number": "562-429-5965",
            "fax_number": "562-429-7318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASIAGO",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "032268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.