Active NPI
Sergey Oumnov, DDS
- Dentist
- Redwood City, CA
National Provider Identifier
1992917389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 42390
- Practice address
- 114 Birch St
Suite C
Redwood City, CA 94062-1398 - Phone
- (650) 365-5546
- Fax
- (650) 364-7776
- NPI assigned
- May 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 42390 | CA | Primary |
Addresses
Primary practice location
114 Birch St
Suite C
Redwood City, CA 94062-1398
Mailing address
114 Birch St
Suite C
Redwood City, CA 94062-1398
Phone (650) 365-5546
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42390 | Other | CA | LICENSE |
| B42390 01 | Other | CA | MEDI CAL PROVIDER NUMBER |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992917389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 BIRCH ST",
"address_2": "SUITE C",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940621398",
"telephone_number": "650-365-5546",
"fax_number": "650-364-7776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 BIRCH ST",
"address_2": "SUITE C",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940621398",
"telephone_number": "650-365-5546",
"fax_number": "650-364-7776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OUMNOV",
"first_name": "SERGEY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "42390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "42390",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI CAL PROVIDER NUMBER",
"identifier": "B42390 01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.