Dr Dutran Tyler Do, MD, DMD in Los Angeles, CA - Medicare Oral & Maxillofacial Surgery Provider

Dr Dutran Tyler Do, MD, DMD is a medicare enrolled "Oral & Maxillofacial Surgery" provider in Los Angeles, California. His current practice location is 12401 Wilshire Blvd Ste 104, Los Angeles, California. You can reach out to his office (for appointments etc.) via phone at (203) 200-7280.

Dr Dutran Tyler Do is licensed to practice in California (license number C139636) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053490961.

Contact Information

	Dr Dutran Tyler Do, MD, DMD
	12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025-1015
	(203) 200-7280
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Dutran Tyler Do
Gender	Male
Speciality	Oral & Maxillofacial Surgery
Location	12401 Wilshire Blvd Ste 104, Los Angeles, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1053490961
Provider Enumeration Date: 11/02/2006
Last Update Date: 02/27/2022

Medicare PECOS Information:

PECOS PAC ID: 6901095629
Enrollment ID: I20110225000182

Medical Identifiers

Medical identifiers for Dr Dutran Tyler Do such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1053490961	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	052760 (New York)	Secondary
122300000X	Dentist	64626 (California)	Secondary
204E00000X	Oral & Maxillofacial Surgery	049194 (Connecticut)	Secondary
204E00000X	Oral & Maxillofacial Surgery	257471 (New York)	Secondary
204E00000X	Oral & Maxillofacial Surgery	C139636 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Dutran Tyler Do allows following entities to bill medicare on his behalf.

Entity Name	Icahn School Of Medicine At Mount Sinai
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1609120674 PECOS PAC ID: 8224282926 Enrollment ID: O20130205000439

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Dutran Tyler Do is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Dutran Tyler Do, MD, DMD 12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025-1015 Ph: (203) 200-7280	Dr Dutran Tyler Do, MD, DMD 12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025-1015 Ph: (203) 200-7280

Dr Dutran Tyler Do, MD, DMD - Medicare in Los Angeles, CA