Individual provider Active NPI

Michael Shirvani, DDS

  • Dentist
  • Burbank, CA
National Provider Identifier
1013035849
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
49995 Issued in CA
Practice address
354 E Angeleno Ave
Burbank, CA 91502-1311
Phone
(818) 846-2858
Fax
(818) 846-5798
NPI assigned
Mar 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 49995 CA Primary

Addresses

Primary practice location

354 E Angeleno Ave
Burbank, CA 91502-1311

Mailing address

354 E Angeleno Ave
Burbank, CA 91502-1311
Phone (818) 846-2858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200124000045 CA Practitioner - DentistPractitioner - Oral Surgery 6204261035

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
49995CAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013035849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 E ANGELENO AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021311",
            "telephone_number": "818-846-2858",
            "fax_number": "818-846-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 E ANGELENO AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021311",
            "telephone_number": "818-846-2858",
            "fax_number": "818-846-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRVANI",
        "first_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "49995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.