Active NPI
Tina Heydari
- Dentist
- Chatsworth, CA
National Provider Identifier
1043074339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112211
- Practice address
- 10316 Mason Ave
Chatsworth, CA 91311-3305 - Phone
- (678) 910-2397
- NPI assigned
- Feb 8, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 112211 | CA | Primary |
Addresses
Primary practice location
10316 Mason Ave
Chatsworth, CA 91311-3305
Mailing address
10316 Mason Ave
Chatsworth, CA 91311-3305
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251010002050 | CA | Order and Referring Only - Dentist | 5496252702 |
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": "1707350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1043074339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10316 MASON AVE",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913113305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10316 MASON AVE",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913113305",
"telephone_number": "678-910-2397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEYDARI",
"first_name": "TINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-08",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chatsworth, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.