NPIMap

Organization Active NPI

Jiravat Wangwongvivat, D.D.S. , a Professional Corporation

  • General Practice Dentistry
  • North Hollywood, CA
National Provider Identifier
1912996455
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
40201 Issued in CA
Legal business name
JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION
Practice address
12724 Sherman Way
North Hollywood, CA 91605-5031
Phone
(818) 765-8280
Fax
(818) 765-8454
NPI assigned
Oct 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jiravat Wangwongvivat, D.D.S.NPI 1205853157
Title
President
Phone
(818) 765-8280

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 40201 CA Primary

Addresses

Primary practice location

12724 Sherman Way
North Hollywood, CA 91605-5031

Mailing address

12724 Sherman Way
North Hollywood, CA 91605-5031
Phone (818) 765-8280

Other identifiers 1

IdentifierTypeStateIssuer
B40201-01OtherCAMEDI-CAL I. D. NUMBER

Other names 1

  • Thai Smile Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

12724 Sherman Way
North Hollywood, CA 91605
Phone (818) 765-8280

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912996455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12724 SHERMAN WAY",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916055031",
            "telephone_number": "818-765-8280",
            "fax_number": "818-765-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12724 SHERMAN WAY",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916055031",
            "telephone_number": "818-765-8280",
            "fax_number": "818-765-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WANGWONGVIVAT",
        "authorized_official_first_name": "JIRAVAT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-765-8280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL I. D. NUMBER",
            "identifier": "B40201-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thai Smile Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.