DR. CAROLE SUE RANDOLPH (NPI# 1083876536) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083876536 |
| Entity Type | Individual |
| Full Name | DR. CAROLE SUE RANDOLPH |
| Credential | D.D.S, M.S. |
| Practice Address |
28212 Kelly Johnson Pkwy Suite 100 Valencia CA 91355-5084 |
| Practice Telephone | 6612223000 |
| Mailing Telephone | 6612223000 |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2011-08-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
33037 | CA | Dental Providers |
| Street Address |
28212 KELLY JOHNSON PKWY SUITE 100 |
| City | VALENCIA |
| State | CA |
| Zip Code | 91355-5084 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326043696 | David Goldberg | Dentist | 28212 Kelly Johnson Pkwy, Suite 185, Valencia, CA 91355-5084 | 2005-06-14 |
| 1922510692 | Melissa Wu Perlee | Occupational Therapist | 28212 Kelly Johnson Pkwy, Valencia, CA 91355-5084 | 2017-11-02 |
| 1649712852 | Hannah Goldner | Occupational Therapist | 28212 Kelly Johnson Pkwy, Suite 200, Valencia, CA 91355-5084 | 2016-11-06 |
| 1861846537 | Tamara Leonor Gonzalez | Speech-Language Pathologist | 28212 Kelly Johnson Pkwy, Suite 200, Valencia, CA 91355-5084 | 2016-04-19 |
| 1265808786 | Andrew Tran, Dds, A Dental Corporation | Dentist | 28212 Kelly Johnson Pkwy, Suite 170, Valencia, CA 91355-5084 | 2015-08-19 |
| 1154738235 | Katie Michelle Bevins | Occupational Therapist | 28212 Kelly Johnson Pkwy, 200, Valencia, CA 91355-5084 | 2014-07-21 |
| 1851654990 | Jenna Natalie Queller | Dermatology | 28212 Kelly Johnson Pkwy, Ste 245, Valencia, CA 91355-5092 | 2012-06-22 |
| 1073810800 | Mdiom Inc | General Acute Care Hospital | 28212 Kelly Johnson Pkwy, Suite#215, Valencia, CA 91355-5084 | 2011-02-14 |
| 1942502687 | Universal Pain Management Medical Corp | Pain Medicine | 28212 Kelly Johnson Pkwy, Suite 155, Valencia, CA 91355-5084 | 2010-12-01 |
| 1841460292 | Clare Macaulay Dds, Inc. | Dentist | 28212 Kelly Johnson Pkwy, Suite 205, Valencia, CA 91355-5084 | 2008-03-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447874730 | Deborah Colleen Rheinfurth | Registered Nurse | 25727 Mcbean Parkway, Valencia, CA 91355 | 2020-06-02 |
| 1396368106 | Carla Patricia Ponce | Behavior Technician | 25115 W, Avenue Stanford Suite A100, Santa Clarita, CA 91355 | 2020-05-27 |
| 1578197661 | Kathleen Megan Murphy Cross | Counselor | 24307 Magic Mountain Pkwy, #260, Valencia, CA 91355 | 2020-02-27 |
| 1780226340 | Logan Veis | Behavior Technician | 25515 Avenue Stanford, Suite A100, Valencia, CA 91355 | 2019-10-15 |
| 1376192906 | Yosef Desta | Behavior Technician | 25115 Ave Standard, Suit A100, Valencia, CA 91355 | 2019-09-06 |
| 1063060960 | Michauni Kimbrew | Behavioral Analyst | 27502 Ave Scott, Ste A, Santa Clarita, CA 91355 | 2019-09-04 |
| 1427607357 | Alissa Meadow Myatt | Social Worker | Henry Mayo Newhall Hospital 23845 Mcbean Parkway, Valencia, CA 91355 | 2019-09-04 |
| 1124672761 | Genon Catarroja | Behavior Technician | 25115 W. Avenue Stanford Suite A100, Valencia, CA 91355 | 2019-08-01 |
| 1730675455 | Jaquelyn Marlene Escobar | Community Health Worker | 24525 Town Center Drive, Valencia, CA 91355 | 2018-07-05 |
| 1265922843 | Jomil Prenzirose Conste | Behavior Technician | 25115 Avenue M14 Suite A, Valencia, CA 91355 | 2018-05-18 |
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| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356472278 | Eileen Clare Zierhut | Dentist | 27674 Newhall Ranch Rd Unit 75, Valencia, CA 91355-4020 | 2007-03-09 |
| 1972655009 | Reza Salmassian | Dentist | 24001 Newhall Ranch Rd, Suite 220, Valencia, CA 91355-5703 | 2007-01-17 |
| 1326108895 | Miryam Susana Miyamoto | Dentist | 23333 Cinema Dr, Suite #200, Valencia, CA 91355-5432 | 2006-12-12 |
| 1770065963 | Michael Tuan Hoang | Dentist | 23838 Valencia Blvd, Valencia, CA 91355-5319 | 2018-09-04 |
| 1861619892 | Bernard Chang | Dentist | 27450 Tourney Rd, Suite 120, Valencia, CA 91355 | 2007-04-19 |
| 1881818243 | Timothy Allen Gault Sr. | Dentist | 25880 Tournament Rd, Suite 221, Valencia, CA 91355 | 2007-04-13 |
| 1598899668 | Eileen C Zierhut, Dds, Inc Apdc | Dentist | 27674 Newhall Ranch Rd Unit 75, Valencia, CA 91355-4020 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861091720 | Ellen Im Dds Inc | Dentist | 13422 Pomerado Rd Ste 201, Poway, CA 92064-3548 | 2020-10-21 |
| 1104425370 | Jack Bayraymyan Dental Group Inc. | Dentist | 2621 Zoe Ave Ste A, Huntington Park, CA 90255-4131 | 2020-10-20 |
| 1669071825 | Jack Bayraymyan Dental Group Inc. | Dentist | 418 E Glenoaks Blvd Ste 202, Glendale, CA 91207-2093 | 2020-10-20 |
| 1891394060 | Jack Bayraymyan Dental Group Inc. | Dentist | 600 S Alvarado St Ste 200-201, Los Angeles, CA 90057-3314 | 2020-10-20 |
| 1790391209 | Two Front Corp | Dentist | 2408 Grandview Ave, Venice, CA 90291-4938 | 2020-09-21 |
| 1396358453 | Bridget Powers | Dentist | 1000 Ygnacio Valley Rd, Walnut Creek, CA 94598-1812 | 2020-08-28 |
| 1144832221 | Manjeet Samra Dental Corporation | Dentist | 1700 Mchenry Ave Ste 16b, Modesto, CA 95350-4319 | 2020-08-19 |
| 1154932150 | Jacqueline Morgan Payne | Dentist | 1820 Sonoma Ave Ste 36, Santa Rosa, CA 95405-6617 | 2020-08-12 |
| 1922617802 | Andrew Levin | Dentist | 7891 Talbert Ave # 2, Huntington Beach, CA 92648-8612 | 2020-07-27 |
| 1861001885 | Robert Berger | Dentist | 2529 Via Sanchez, Palos Verdes Estates, CA 90274-2805 | 2020-07-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.