Active NPI
Jack Sabounjian
- General Practice Dentistry
- Pasadena, CA
National Provider Identifier
1972659548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 46129
- Practice address
- 81 N Lake Ave
Pasadena, CA 91101-1825 - Phone
- (562) 863-3457
- NPI assigned
- Jan 26, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 46129 | CA | Primary |
Addresses
Primary practice location
81 N Lake Ave
Pasadena, CA 91101-1825
Mailing address
PO Box 3430
Fullerton, CA 92834-3430
Phone (562) 863-3457
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150731016164 | CA | Order and Referring Only - Dentist | 9638483829 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46129 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972659548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3430",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928343430",
"telephone_number": "562-863-3457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81 N LAKE AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911011825",
"telephone_number": "562-863-3457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SABOUNJIAN",
"first_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "46129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.