Active NPI
Simon Yashari, D.D.S.,M.B.A., ORTHO
- Orthodontics and Dentofacial Orthopedics Dentistry
- Ridgecrest, CA
National Provider Identifier
1063784239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 64413
- Practice address
- 1101 N Norma St
Ridgecrest, CA 93555-3157 - Phone
- (760) 446-2233
- NPI assigned
- Feb 3, 2012
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6198 | NV | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 64413 | CA | Primary |
Addresses
Primary practice location
1101 N Norma St
Ridgecrest, CA 93555-3157
Mailing address
8200 Kroll Way
#246
Bakersfield, CA 93311-1167
Phone (310) 770-8121
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 |
|---|---|---|---|---|
| I20151006001663 | CA | Order and Referring Only - Dentist | 4183932437 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6198 | NV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438646400000",
"number": "1063784239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8200 KROLL WAY",
"address_2": "#246",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933111167",
"telephone_number": "310-770-8121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 N NORMA ST",
"city": "RIDGECREST",
"state": "CA",
"postal_code": "935553157",
"telephone_number": "760-446-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YASHARI",
"first_name": "SIMON",
"name_prefix": "Dr.",
"credential": "D.D.S.,M.B.A., ORTHO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-03",
"last_updated": "2015-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "6198",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "64413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgecrest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; 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.