NPIMap

Organization Active NPI

Ian Iwane DDS

  • Dentist
  • Berkeley, CA
National Provider Identifier
1962817882
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
52870 Issued in CA
Legal business name
IAN IWANE DDS
Practice address
1536 Blake St
None
Berkeley, CA 94703-1806
Phone
(415) 845-0217
NPI assigned
Jun 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Authorized official

Name
Ian Michio Iwane, DDSNPI 1467867374
Title
Owner
Phone
(415) 845-0217

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 52870 CA Primary

Addresses

Primary practice location

1536 Blake St
None
Berkeley, CA 94703-1806

Mailing address

1536 Blake St
None
Berkeley, CA 94703-1806
Phone (415) 845-0217

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1962817882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 BLAKE ST",
            "address_2": "NONE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031806",
            "telephone_number": "415-845-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 BLAKE ST",
            "address_2": "NONE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031806",
            "telephone_number": "415-845-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IAN IWANE DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "IWANE",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "MICHIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-845-0217",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "52870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.