Kourosh Seifolahi Bazarjani, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401417219 Issued in VA

Practice address

1801 Robert Fulton Dr Ste 100
Reston, VA 20191-4347

Phone

(703) 495-3333

NPI assigned

Oct 12, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Total Dental Arts, LLC

  • Dental Clinic/Center
  • Centreville, VA
  • NPI 1457042442
  NPD
• Dentlux Smile Aesthetics

  • Dentist
  • Reston, VA
  • NPI 1164377420
  NPD (past)
• Virgina Family and Cosmetic Dentistry Inc

  • General Practice Dentistry
  • Reston, VA
  • NPI 1326348350
  NPD (past)

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1093313181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 ROBERT FULTON DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201914347",
            "telephone_number": "703-495-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 ROBERT FULTON DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201914347",
            "telephone_number": "703-495-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1760 Reston Pkwy Ste 415",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201903360",
            "country_code": "US",
            "telephone_number": "703-956-9444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEIFOLAHI BAZARJANI",
        "first_name": "KOUROSH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-12",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417219",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.rtcdental.com/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "RTC Dental",
            "address_1": "1760 Reston Pkwy Ste 415",
            "city": "Reston",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201903360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Latasha Monique Scott, LPC
• Charles N Seal, MD
• Mia Mackenzie Sebastian
• Theodore Stewart Sebastien, MD
• Elizabeth Naar Sedaghatfar, L.C.S.W.
• Emma Morgan Selby
• Tehila Selzer-Putney, PH.D.
• Olivia Seneff, DPT
• Nam Kyung Senerchia
• Alycia Serikstad, LCSW

• Dentist in Reston, VA
• Providers in Reston, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.