NPIMap

Organization Active NPI

UCLA Venice Clinical

  • General Practice Dentistry
  • Venice, CA
National Provider Identifier
1932253184
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D40407 Issued in CA
Legal business name
UCLA VENICE CLINICAL
Practice address
323 Lincoln Blvd
Venice, CA 90291-2842
Phone
(310) 392-4103
Fax
(310) 392-8513
NPI assigned
Jan 23, 2007
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. John Yamamanto, D.D.S.
Title
Clenal Director
Phone
(310) 392-4103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D40407 CA Primary

Addresses

Primary practice location

323 Lincoln Blvd
Venice, CA 90291-2842

Mailing address

323 Lincoln Blvd
Venice, CA 90291-2842
Phone (310) 392-4103

Other identifiers 1

IdentifierTypeStateIssuer
UO1004MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Regents of the Univ of Ca56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

323 Lincoln Blvd
Venice, CA 90291
Phone (310) 392-4103

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932253184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912842",
            "telephone_number": "310-392-4103",
            "fax_number": "310-392-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912842",
            "telephone_number": "310-392-4103",
            "fax_number": "310-392-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCLA VENICE CLINICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YAMAMANTO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CLENAL DIRECTOR",
        "authorized_official_telephone_number": "310-392-4103",
        "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": "D40407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "UO1004",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, 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.