JIRAVAT WANGWONGVIVAT D.D.S. A PROFESSIONAL CORPORATION NPI 1912996455

NPI Information

NPI: 1912996455
Provider Name: JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Organization
Doing Business As: THAI SMILE DENTAL CARE
Address: 12724 SHERMAN WAY
NORTH HOLLYWOOD, CA
ZIP 91605
Phone: (818) 765-8280

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NPI Details

JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION is a general practice dentist in North Hollywood, CA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. JIRAVAT WANGWONGVIVAT, D.D.S. , A PROFESSIONAL CORPORATION NPI is 1912996455. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Thai Smile Dental Care.

The provider's business location address is:

12724 SHERMAN WAY
NORTH HOLLYWOOD, CA
ZIP 91605-031
Phone: (818) 765-8280
Fax: (818) 765-8454

The provider's authorized official is Jiravat Wangwongvivat .
The authorized official title is President and has the following contact phone number (818) 765-8280.

The enumeration date for this NPI number is 10/18/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	40201	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	B40201-01	OTHER	CALIFORNIA	MEDI-CAL I. D. NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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