Active NPI
Jeffrie Maneepetasut, D.M.D
- Dentist
- Los Angeles, CA
National Provider Identifier
1972631059
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Oct 20, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 53468
- Practice address
- 4606 Hollywood Blvd
Suite B
Los Angeles, CA 90027-5462 - Phone
- (617) 312-5663
- NPI assigned
- Mar 1, 2007
- 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 | 53468 | CA | Primary |
Addresses
Primary practice location
4606 Hollywood Blvd
Suite B
Los Angeles, CA 90027-5462
Mailing address
4606 Hollywood Blvd
Suite B
Los Angeles, CA 90027-5462
Phone (617) 312-5663
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53468 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrie Maneepetasut DMD Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Los Angeles, CA
- NPI 1285815340
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366588800000",
"number": "1972631059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4606 HOLLYWOOD BLVD",
"address_2": "SUITE B",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900275462",
"telephone_number": "617-312-5663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4606 HOLLYWOOD BLVD",
"address_2": "SUITE B",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900275462",
"telephone_number": "617-312-5663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANEEPETASUT",
"first_name": "JEFFRIE",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-01",
"last_updated": "2013-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "53468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.