Active NPI
Kourosh Michael Beral, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1063782746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 46749
- Practice address
- 2204 Parnell Ave
Los Angeles, CA 90064-2005 - Phone
- (310) 666-5453
- NPI assigned
- Jan 11, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 46749 | CA | Primary |
Addresses
Primary practice location
2204 Parnell Ave
Los Angeles, CA 90064-2005
Mailing address
5701 S Hoover St
Los Angeles, CA 90037-4045
Phone (310) 666-5453
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 |
|---|---|---|---|---|
| I20160412002017 | CA | Order and Referring Only - Dentist | 7113225954 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46749 | CA | MD | Psychiatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1063782746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5701 S HOOVER ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900374045",
"telephone_number": "310-666-5453",
"fax_number": "323-541-1494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 PARNELL AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900642005",
"telephone_number": "310-666-5453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERAL",
"first_name": "KOUROSH",
"middle_name": "MICHAEL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-11",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "46749",
"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 Jan 11, 2012; 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.