NPIMap

Organization Active NPI

Roya Mirkhan,DMD,MSD,Inc.

  • Dentist
  • San Diego, CA
National Provider Identifier
1003299892
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
44743 Issued in CA
Legal business name
ROYA MIRKHAN,DMD,MSD,INC.
Practice address
12395 El Camino Real
Suite Number 314
San Diego, CA 92130-3082
Phone
(858) 337-6264
Fax
(858) 755-6260
NPI assigned
Jun 30, 2015
Last updated
Jun 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Authorized official

Name
Dr. Roya Nazila Mirkhan, DMD,MSD
Title
President
Phone
(858) 337-6264

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 44743 CA Primary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 44743 CA

Addresses

Primary practice location

12395 El Camino Real
Suite Number 314
San Diego, CA 92130-3082

Mailing address

12395 El Camino Real
Suite Number 314
San Diego, CA 92130
Phone (858) 337-6264

Other identifiers 1

IdentifierTypeStateIssuer
1396866000OtherCADENTISTRY

National Provider Directory

National Provider Directory
Tax ID family
Roya Mirkhan DMD MSD Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12395 El Camino Real
Ste 314
San Diego, CA 92130
Phone (858) 337-6264

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1003299892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL",
            "address_2": "SUITE NUMBER 314",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130",
            "telephone_number": "858-337-6264",
            "fax_number": "858-755-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL",
            "address_2": "SUITE NUMBER 314",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303082",
            "telephone_number": "858-337-6264",
            "fax_number": "858-755-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYA MIRKHAN,DMD,MSD,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "MIRKHAN",
        "authorized_official_first_name": "ROYA",
        "authorized_official_middle_name": "NAZILA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-337-6264",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD,MSD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "44743",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "44743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTISTRY",
            "identifier": "1396866000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.