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DR. KATHERINE AHN WALLACE D.D.S.
NPI 1790843381
Dentist - General Practice in Los Alamitos, CA

Active since December 05, 2006PECOS Enrolled
11121 LOS ALAMITOS BLVD STE 201, LOS ALAMITOS, CA 90720(714) 230-2434 Get Directions Write a Review

NPPES record last updated: July 23, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 23, 2021, Jun 16, 2018, Aug 3, 2017 (3 updates tracked since 2017).

About Dr. Katherine Ahn Wallace D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KATHERINE AHN WALLACE D.D.S. (NPI 1790843381) is an individual general practice provider in Los Alamitos, California, licensed in California (41055) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Huntington Beach.

NPPES Registry Identity

NPI1790843381
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KATHERINE AHN WALLACECredential: D.D.S.
Location Address11121 LOS ALAMITOS BLVD STE 201Los Alamitos, CA 90720-3603
Mailing Address11121 Los Alamitos Blvd Ste 201Los Alamitos, CA 90720-3603 · (714) 230-2434
Phone(714) 230-2434
Sole ProprietorNo
Enumeration DateDecember 5, 2006
Last NPPES UpdateJuly 23, 20213 updates tracked since enumeration
NPPES CertifiedJuly 23, 2021
✔ NPI 1790843381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 41055
Definition
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.
Also ListedDentistTaxonomy 122300000X · License 41055 (CA)
Also ListedDentist · Pediatric DentistryTaxonomy 1223P0221X · License 41055 (CA)
11121 LOS ALAMITOS BLVD STE 201, Los Alamitos, CA 90720
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Secondary Practice Location 1

Location 17801 Center Ave, Suite 101Huntington Beach, CA 92647-9110 · Phone (714) 230-2400

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Katherine Ahn Wallace D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90720 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

WALID FARAJ, D.O., A PROFESSIONAL CORPORATION
Family Medicine
11121 LOS ALAMITOS BLVD STE 201
LOS ALAMITOS, CA 90720
Orange County (714) 230-2424
WALID FARAJ, D.O., A PROFESSIONAL CORPORATION
Family Medicine
11121 LOS ALAMITOS BLVD STE 201
LOS ALAMITOS, CA 90720
Orange County (714) 230-2424

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 Katherine Wallace's NPI number?

The NPI number for Katherine Wallace is 1790843381. It was assigned to this individual provider in the NPPES registry on December 5, 2006.

Where is Katherine Wallace located?

Katherine Wallace practices at 11121 Los Alamitos Blvd Ste 201, Los Alamitos, CA 90720. The listed phone number is (714) 230-2434.

What is Katherine Wallace's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Katherine Wallace enrolled in Medicare?

Yes. Katherine Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Katherine Wallace was last updated on July 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.