Active NPI
Kian Zabi Momeni, DDS
- Pediatric Dentistry
- Woodbridge, VA
National Provider Identifier
1043731086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401416051
- Practice address
- 12602 Lake Ridge Dr
Woodbridge, VA 22192-2335 - Phone
- (703) 490-5050
- NPI assigned
- Jun 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 0401416051 | VA | Primary |
Addresses
Primary practice location
12602 Lake Ridge Dr
Woodbridge, VA 22192-2335
Mailing address
600 W St NW
Washington, DC 20059-1022
Other practice location 1
600 W st NW
Washington, DC 20059
Phone (202) 806-0308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401416051 | VA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gina C Pham DDS PC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Woodbridge, VA
- NPI 1801029590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590537600000",
"number": "1043731086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 W ST NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200591022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12602 LAKE RIDGE DR",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221922335",
"telephone_number": "703-490-5050"
}
],
"practiceLocations": [
{
"address_1": "600 W st NW",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "20059",
"country_code": "US",
"telephone_number": "202-806-0308",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOMENI",
"first_name": "KIAN",
"middle_name": "ZABI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-29",
"last_updated": "2020-05-27",
"certification_date": "2020-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401416051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.