DR. DUTRAN TYLER DO MD, DMD
NPI 1053490961
Oral & Maxillofacial Surgery in Los Angeles, CA
About Dr. Dutran Tyler Do Md, Dmd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. DUTRAN TYLER DO MD, DMD (NPI 1053490961) is an individual oral & maxillofacial surgery provider in Los Angeles, California, licensed in California (C139636) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Dutran Tyler Do Md, Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Dutran Do reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Elmhurst, NY 11373
- Reassigned Medicare billing, New York enrollment
- 836 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LOS ANGELES, CA 90025
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dutran Do's NPI number?
The NPI number for Dutran Do is 1053490961. It was assigned to this individual provider in the NPPES registry on November 2, 2006.
Where is Dutran Do located?
Dutran Do practices at 12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025. The listed phone number is (203) 200-7280.
What is Dutran Do's specialty?
The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.
Is Dutran Do enrolled in Medicare?
Yes. Dutran Do is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Dutran Do's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Dutran Do reassigns Medicare benefits to Icahn School Of Medicine At Mount Sinai (Elmhurst, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dutran Do's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Dutran Do accept?
Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Florida Combined Life and HRI Dental & Vision and 3 other insurers list Dutran Do as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Dutran Do was last updated on February 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Dutran Tyler Do, MD, DMD · NPI 1053490961
Oral & Maxillofacial Surgery physician in Los Angeles, California. Individual provider, active in the CMS NPPES registry since November 2, 2006.
## Identity
- **NPI:** 1053490961 (Entity type: Individual)
- **Enumerated:** November 2, 2006
- **Primary specialty:** Oral & Maxillofacial Surgery · taxonomy 204E00000X
- **State license:** C139636 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 12401 WILSHIRE BLVD STE 104, Los Angeles, CA 90025-1015
- **Phone:** (203) 200-7280
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Icahn School Of Medicine At Mount Sinai (NPI 1578817540, Elmhurst, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 27, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1053490961) · Data from the CMS NPPES public registry.