Individual provider Active NPI

Elham Javidan-Nejad, DDS

  • Dentist
  • Detroit, MI
National Provider Identifier
1003126350
Registry record updated Jan 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901020313 Issued in MI
Practice address
5705 W Vernor Hwy
Detroit, MI 48209-2157
Phone
(313) 842-3770
Fax
(313) 842-6665
NPI assigned
Oct 19, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901020313 MI Primary

Addresses

Primary practice location

5705 W Vernor Hwy
Detroit, MI 48209-2157

Mailing address

5705 W Vernor Hwy
Detroit, MI 48209-2157
Phone (313) 842-3770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160104000930 MI Order and Referring Only - DentistPractitioner - Dentist 1557663846

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389830400000",
    "number": "1003126350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5705 W VERNOR HWY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482092157",
            "telephone_number": "313-842-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5705 W VERNOR HWY",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482092157",
            "telephone_number": "313-842-3770",
            "fax_number": "313-842-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVIDAN-NEJAD",
        "first_name": "ELHAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2014-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.