Individual provider Active NPI

John Charles Olson, D.D.S.

  • General Practice Dentistry
  • Huntington Beach, CA
National Provider Identifier
1952525669
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
24158 Issued in CA
Practice address
16152 Beach Blvd Ste 160-E
Huntington Beach, CA 92647-3806
Phone
(714) 847-6020
Fax
(714) 847-6020
NPI assigned
Apr 12, 2007
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 24158 CA Primary

Addresses

Primary practice location

16152 Beach Blvd Ste 160-E
Huntington Beach, CA 92647-3806

Mailing address

16152 Beach Blvd Ste 160-E
Huntington Beach, CA 92647-3806
Phone (714) 847-6020

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
I20170223001952 CA Order and Referring Only - DentistPractitioner - Dentist 2163706847

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24158CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952525669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16152 BEACH BLVD STE 160-E",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473806",
            "telephone_number": "714-847-6020",
            "fax_number": "714-847-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16152 BEACH BLVD STE 160-E",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473806",
            "telephone_number": "714-847-6020",
            "fax_number": "714-847-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JOHN",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "24158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.