ELLEN IM DDS INC (NPI# 1861091720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861091720 |
| Entity Type | Organization |
| Organization Name | ELLEN IM DDS INC |
| Practice Address |
13422 Pomerado Rd Ste 201 Poway CA 92064-3548 |
| Practice Telephone | 8586796660 |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |
| Authorized Official Name | DR. ELLEN IM (OWNER/OPERATOR) |
| Authorized Official Telephone | 8586796660 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Kids Dental Care | Doing Business As Name - Organization |
| Street Address |
13422 POMERADO RD STE 201 |
| City | POWAY |
| State | CA |
| Zip Code | 92064-3548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194357384 | Prabha Choudhary | Student in an Organized Health Care Education/Training Program | 17555, Corte Lomas Verdes, Poway, CA 92064 | 2020-02-06 |
| 1770143968 | Theresa Marie Morales | In Home Supportive Care | 15352 Running Deer Trl, Poway, CA 92064 | 2019-06-19 |
| 1689230997 | Jaclyn Miller | Audiologist | Health Medical Group, 15525 Pomerado Road Suite C-1, Poway, CA 92064 | 2019-05-13 |
| 1205306842 | Angelita Fuentes | Behavior Technician | 12975 Brookprinter Place Suite 250, Poway, CA 92064 | 2018-11-27 |
| 1396235271 | Michael Cutler, M.d., P.C. | Clinic/Center | 12285 Scripps Poway Pkwy Ste 103, Poway, CA 92064 | 2018-05-16 |
| 1720576671 | Jodi A Mcgrady Dmd, Ms, Adc | Dentist | 12350 Oak Knoll Rd, Poway, CA 92064 | 2018-04-26 |
| 1295237139 | Michelle J. Beaupre | Social Worker | 204 Poway Rd., Poway, CA 92064 | 2018-03-07 |
| 1669918165 | Restore Detox Centers | Substance Abuse Rehabilitation Facility | 14099 Sky Mountain Trail, Poway, CA 92064 | 2017-01-09 |
| 1205382561 | Nightingale Meyou | Pharmacist | 5615 Pomerado Rd, Poway, CA 92064 | 2016-08-28 |
| 1578017232 | Elan Lee | Dentist | 13035 Pomerado Road Suite B, Poway, CA 92064 | 2016-08-11 |
| Find all providers in zip 92064 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720576671 | Jodi A Mcgrady Dmd, Ms, Adc | Dentist | 12350 Oak Knoll Rd, Poway, CA 92064 | 2018-04-26 |
| 1073935912 | Bruce B. Baker Dmd Apdc | Dentist | 13422-201 Pomerado Rd., Poway, CA 92064 | 2014-01-13 |
| 1619243227 | Robert W. Fattouch D.m.d., P.C. | Dentist | 15835 Pomerado Rd., Suite 303, Poway, CA 92064-2073 | 2012-03-28 |
| 1598093643 | Sambath Sem Tiep | Dentist | 15725 Pomerado Rd Ste 206, Poway, CA 92064-2059 | 2009-12-01 |
| 1356499644 | Bruce B Baker | Dentist | 13422 Pomerado Rd, Ste #201, Poway, CA 92064-3548 | 2007-01-05 |
| 1144386194 | Robert W Fattouch | Dentist | 15835 Pomerado Rd Ste 303, Poway, CA 92064-2043 | 2006-12-27 |
| 1548804313 | Sambath Tiep Dds, PC | Dentist | 15725 Pomerado Rd Ste 206, Poway, CA 92064-2059 | 2019-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385227 | Johnson Ann Wong Dental Corporation | Dentist | 6512 N Figueroa St Ste 3, Los Angeles, CA 90042-2155 | 2020-10-26 |
| 1205440211 | Jessica Choi, Dmd, Dental Corporation | Dentist | 2318 Huntington Dr, San Marino, CA 91108-2641 | 2020-09-08 |
| 1659985802 | Rw Fattouch Dmd, Inc. | Dentist | 42210 Lyndie Ln Ste 100, Temecula, CA 92591-3604 | 2020-09-04 |
| 1174136998 | Armand Begian Dds Inc. | Dentist | 4021 Mission Oaks Blvd # 180, Camarillo, CA 93012-5156 | 2020-08-31 |
| 1164035473 | Armand Begian Dds Inc. | Dentist | 3687 Las Posas Rd Ste 180, Camarillo, CA 93010-1431 | 2020-08-26 |
| 1518577972 | Michael Vincent Laureola Dds Inc | Dentist | 2862 Unit A Canyon Springs Parkway, Riverside, CA 92507 | 2020-07-31 |
| 1396360384 | Drs Salem and Soliman Dental Corp | Dentist | 2119 E Hatch Rd Ste Bandc, Modesto, CA 95351-4814 | 2020-06-15 |
| 1689299471 | Abhishek Batra | Dentist | 11052 Evans St, Loma Linda, CA 92354-2709 | 2020-06-08 |
| 1194348060 | Bryan Chao | Dentist | 1895 Mowry Ave Ste 121, Fremont, CA 94538-1736 | 2020-05-26 |
| 1255953618 | Mohammad Abul-fielat Dds Inc | Dentist | 3825 Tyler St, Riverside, CA 92503 | 2020-05-08 |
| Find all providers with the same taxonomy | ||||
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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.