Lydia Koernianingsih DDS a Prof Corp

Primary specialty

DentistTaxonomy code 122300000X

License

48488 Issued in CA

Legal business name

LYDIA KOERNIANINGSIH DDS A PROF CORP

Doing business as

LDJ Family Dentistry

Practice address

1125 E 17TH St Ste W234
Santa Ana, CA 92701-2228

Phone

(714) 558-4895

Fax

(714) 558-4896

NPI assigned

Mar 6, 2013

Last updated

Jan 24, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lydia KoernianingsihNPI 1083817423

Title

Dentist / Owner

Phone

(714) 558-4895

Specialties & licenses 1

Addresses

Other names 1

• LDJ Family Dentistry Doing business as

Locations

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.

• Lydia Koernianingsih, DDS

  • Dentist
  • Santa Ana, CA
  • NPI 1083817423
  NPD Authorized official

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579824000000",
    "number": "1922349521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E 17TH ST STE W234",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012228",
            "telephone_number": "714-558-4895",
            "fax_number": "714-558-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E 17TH ST STE W234",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012228",
            "telephone_number": "714-558-4895",
            "fax_number": "714-558-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIA KOERNIANINGSIH DDS A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A",
        "authorized_official_last_name": "KOERNIANINGSIH",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "714-558-4895"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "48488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LDJ Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LDJ Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teyler Quynh Thi Ly
• Tiffany Ly, BA
• Tin Lang Quoc Ly, PHARMD
• Tuan Quoc Ly, D.D.S.
• Joey Catherine Lyall
• Erin Christine Lynch, M.S., MFTI
• Tim Lynch, MD
• Ebony Sheraun Lynk
• Whitney Alyse Lynott, RD
• William V. Lyon, R.D.O. R.C.L.D.

• Dentist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.