Jason Kenji Reyda, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

48983 Issued in CA

Practice address

5200 Snyder LN
Suite 1
Rohnert Park, CA 94928-2929

Phone

(707) 585-3160

NPI assigned

Jan 21, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 10, 2016 through Nov 10, 2026

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jason Kenji Reyda, DDS, Professional Corporation

  • General Practice Dentistry
  • Rohnert Park, CA
  • NPI 1811481575
  NPD (past) Authorized official

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432252800000",
    "number": "1962707976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SNYDER LN",
            "address_2": "SUITE 1",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282929",
            "telephone_number": "707-585-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 SNYDER LN",
            "address_2": "SUITE 1",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282929",
            "telephone_number": "707-585-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYDA",
        "first_name": "JASON",
        "middle_name": "KENJI",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-21",
        "last_updated": "2015-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvia Marie Reed, RN
• Nicholas Steven Regennitter, MD
• Rebecca Renelus, DDS
• Cynthia Sue Renfrew, RN,MS,FNP
• Laura Renshaw
• Joel Reynolds
• Darwin Rivera
• Elise Robbins
• Robert Y Chiang DDS Inc
• Stephanie Roberts, AMFT

• General Practice Dentistry in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.