Active NPI
Sean M Full, DDS
- Dentist
- Pico Rivera, CA
National Provider Identifier
1962058313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104114
- Practice address
- 8963 Washington Blvd
Pico Rivera, CA 90660-3728 - Phone
- (323) 513-0842
- NPI assigned
- Aug 12, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 104114 | CA | Primary |
Addresses
Primary practice location
8963 Washington Blvd
Pico Rivera, CA 90660-3728
Mailing address
23770 Canyon Vista CT
Diamond Bar, CA 91765-6115
Phone (909) 618-2545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104114 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1962058313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23770 CANYON VISTA CT",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917656115",
"telephone_number": "909-618-2545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8963 WASHINGTON BLVD",
"city": "PICO RIVERA",
"state": "CA",
"postal_code": "906603728",
"telephone_number": "323-513-0842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULL",
"first_name": "SEAN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-12",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pico Rivera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.