Active NPI
Vladimir Vysotsky, DDS
- General Practice Dentistry
- Northridge, CA
National Provider Identifier
1992987168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 43266
- Practice address
- 19520 Nordhoff St Ste 17
Northridge, CA 91324-2444 - Phone
- (818) 701-9400
- Fax
- (818) 701-9083
- NPI assigned
- Nov 29, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 43266 | CA | Primary |
Addresses
Primary practice location
19520 Nordhoff St Ste 17
Northridge, CA 91324-2444
Mailing address
19520 Nordhoff St Ste 17
Northridge, CA 91324-2444
Phone (818) 701-9400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 523875 | Other | CA | MEDICAID PIN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43266 | CA | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196294400000",
"number": "1992987168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19520 NORDHOFF ST STE 17",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913242444",
"telephone_number": "818-701-9400",
"fax_number": "818-701-9083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19520 NORDHOFF ST STE 17",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913242444",
"telephone_number": "818-701-9400",
"fax_number": "818-701-9083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VYSOTSKY",
"first_name": "VLADIMIR",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-29",
"last_updated": "2007-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "43266",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID PIN",
"identifier": "523875",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.