Healthcare Provider Details

I. General information

NPI: 1740015080
Provider Name (Legal Business Name): JAMES PENNINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 HOMESTEAD RD
SANTA CLARA CA
95051-5353
US

IV. Provider business mailing address

438 OAK GROVE DR APT 503
SANTA CLARA CA
95054-4330
US

V. Phone/Fax

Practice location:
  • Phone: 661-310-1186
  • Fax:
Mailing address:
  • Phone: 720-519-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: