Active NPI
Mehrnoosh Moghaddam, D.M.D
- General Practice Dentistry
- Newark, CA
National Provider Identifier
1053565101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 43716
- Practice address
- 7332 Thornton Ave
Newark, CA 94560-3647 - Phone
- (510) 796-3333
- Fax
- (510) 796-3480
- NPI assigned
- Nov 14, 2008
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 43716 | CA | Primary |
Addresses
Primary practice location
7332 Thornton Ave
Newark, CA 94560-3647
Mailing address
7332 Thornton Ave
Newark, CA 94560-3647
Phone (510) 796-3333
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 |
|---|---|---|---|
| 43716 | CA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226620800000",
"number": "1053565101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7332 THORNTON AVE",
"city": "NEWARK",
"state": "CA",
"postal_code": "945603647",
"telephone_number": "510-796-3333",
"fax_number": "510-796-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7332 THORNTON AVE",
"city": "NEWARK",
"state": "CA",
"postal_code": "945603647",
"telephone_number": "510-796-3333",
"fax_number": "510-796-3480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHADDAM",
"first_name": "MEHRNOOSH",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-14",
"last_updated": "2008-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "43716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.