Active NPI
Ardy Sadehkhou, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1053758904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62460
- Practice address
- 10921 Wilshire Blvd
1212
Los Angeles, CA 90024-3906 - Phone
- (310) 443-4000
- Fax
- (310) 870-9765
- NPI assigned
- Jun 3, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D008720 | AZ | |
| Dentist | 122300000X | 62460 | CA | Primary |
Addresses
Primary practice location
10921 Wilshire Blvd
1212
Los Angeles, CA 90024-3906
Mailing address
10921 Wilshire Blvd
1212
Los Angeles, CA 90024-3906
Phone (310) 443-4000
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 |
|---|---|---|---|
| 62460 | CA | MD | Clinical Social Worker |
| D008720 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1053758904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10921 WILSHIRE BLVD",
"address_2": "1212",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243906",
"telephone_number": "310-443-4000",
"fax_number": "310-870-9765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10921 WILSHIRE BLVD",
"address_2": "1212",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243906",
"telephone_number": "310-443-4000",
"fax_number": "310-870-9765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SADEHKHOU",
"first_name": "ARDY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-03",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D008720",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.