Poppy Widyastuti The, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

26289 Issued in CA

Practice address

20800 Sherman Way
Winnetka, CA 91306-2707

Phone

(818) 883-2273

Fax

(818) 896-1074

NPI assigned

May 14, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1992911408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8902 WOODMAN AVE",
            "city": "ARLETA",
            "state": "CA",
            "postal_code": "913316401",
            "telephone_number": "818-830-7133",
            "fax_number": "818-830-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20800 SHERMAN WAY",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913062707",
            "telephone_number": "818-883-2273",
            "fax_number": "818-896-1074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THE",
        "first_name": "POPPY",
        "middle_name": "WIDYASTUTI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "26289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083624423",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538130893",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kelley Michelle Tapia, LMFT
• The Winners Edge:Physical Therapy,Sports Performance, Consulting Inc
• Sarah Alexis Thomason
• Michael Tidstrand, BA, MA, LPCC
• Joshua Daquiz Tolentino
• Roza Tonoyan
• Sharon K. Tso, D.D.S.

• Pediatric Dentistry in Winnetka, CA
• Providers in Winnetka, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; 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.