Individual provider Active NPI

Farnaz Younessian

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fairfax, VA
National Provider Identifier
1053993295
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
0401416814 Issued in VA
Practice address
3903 Fair Ridge Dr Ste 215
Fairfax, VA 22033-2945
Phone
(571) 559-1343
NPI assigned
Apr 27, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 0401416814 VA Primary

Addresses

Primary practice location

3903 Fair Ridge Dr Ste 215
Fairfax, VA 22033-2945

Mailing address

10610 Canfield St
Fairfax, VA 22030-8155
Phone (949) 527-8434

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

LicenseStateTypeSpecialty
0401416814VAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1053993295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10610 CANFIELD ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220308155",
            "telephone_number": "949-527-8434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 FAIR RIDGE DR STE 215",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332945",
            "telephone_number": "571-559-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNESSIAN",
        "first_name": "FARNAZ",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401416814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.