NPIMap

Organization Active NPI

I Zak DDS Prof Dental Corp

  • Dentist
  • San Diego, CA
National Provider Identifier
1922748755
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
I ZAK DDS PROF DENTAL CORP
Practice address
5625 Ruffin Rd Ste 200
San Diego, CA 92123-6392
Phone
(858) 569-9651
NPI assigned
Mar 30, 2022
Last updated
Mar 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Authorized official

Name
Ilya ZakNPI 1023165255
Title
President/Ceo
Phone
(310) 805-5201

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU
Periodontics 1223P0300X NU
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

5625 Ruffin Rd Ste 200
San Diego, CA 92123-6392

Mailing address

10501 Lakewood Blvd
Downey, CA 90241-2709

Other names 1

  • Dr. Zak San Diego Dental Care & Orthodontics Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231220003181 CA Part B Supplier - Clinic/Group Practice 9133579808 Receives reassigned benefits from 20 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Temecula, CA; Whittier, CA; Ventura, CA; Valencia, CA; Simi Valley, CA; Santa Barbara, CA; San Diego, CA; Long Beach, CA…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
I Zak DDS Prof Dental Corp14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1922748755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10501 LAKEWOOD BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902412709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5625 RUFFIN RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921236392",
            "telephone_number": "858-569-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I ZAK DDS PROF DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "ZAK",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "310-805-5201"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Zak San Diego Dental Care & Orthodontics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.