DR. JOSE CARLOS DAUDT POLIDO DDS
NPI 1104912377
Dentist - Pediatric Dentistry in Los Angeles, CA
About Dr. Jose Carlos Daudt Polido Dds NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JOSE CARLOS DAUDT POLIDO DDS (NPI 1104912377) is an individual pediatric dentistry provider in Los Angeles, California, licensed in California (39870) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
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. Jose Carlos Daudt Polido Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jose Polido reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Los Angeles, CA 90027
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: Childrens Hospital Los Angeles Medical Group Inc
- 1,281 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90027 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LOS ANGELES, CA 90027
LOS ANGELES, CA 90027
LOS ANGELES, CA 90027
LOS ANGELES, CA 90027
LOS ANGELES, CA 90027
LOS ANGELES, CA 90027
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 Jose Polido's NPI number?
The NPI number for Jose Polido is 1104912377. It was assigned to this individual provider in the NPPES registry on October 5, 2006.
Where is Jose Polido located?
Jose Polido practices at 4650 W Sunset Blvd Ms# 116, Los Angeles, CA 90027. The listed phone number is (323) 361-2130.
What is Jose Polido's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.
Is Jose Polido enrolled in Medicare?
Yes. Jose Polido is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jose Polido's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jose Polido reassigns Medicare benefits to Children's Hospital Los Angeles Medical Group, Inc. (Los Angeles, CA). 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 Jose Polido's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jose Polido 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 Humana and 1 other insurer list Jose Polido 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 Jose Polido was last updated on March 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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. Jose Carlos Daudt Polido, DDS · NPI 1104912377
Pediatric Dentistry provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since October 5, 2006.
## Identity
- **NPI:** 1104912377 (Entity type: Individual)
- **Enumerated:** October 5, 2006
- **Primary specialty:** Dentist - Pediatric Dentistry · taxonomy 1223P0221X
- **State license:** 39870 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 4650 W SUNSET BLVD, MS# 116, Los Angeles, CA 90027-6062
- **Phone:** (323) 361-2130 · **Fax:** (323) 361-1090
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Children's Hospital Los Angeles Medical Group, Inc. (NPI 1265530653, Los Angeles, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 18, 2013
- **Other identifiers:** Medicaid D39870 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1104912377) · Data from the CMS NPPES public registry.