Active NPI
Hamid Reza Ebrahimi, DDS
- Dentist
- Loma Linda, CA
National Provider Identifier
1104266527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62499
- Practice address
- 25597 Lane St
Loma Linda, CA 92354-2412 - Phone
- (909) 680-9190
- NPI assigned
- Jun 29, 2013
- 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 | 62499 | CA | Primary |
Addresses
Primary practice location
25597 Lane St
Loma Linda, CA 92354-2412
Mailing address
25597 Lane St
Loma Linda, CA 92354-2412
Phone (909) 680-9190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62499 | Other | CA | LICENSE NUMBER |
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 |
|---|---|---|---|
| 62499 | CA | MD | Oncology Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372723200000",
"number": "1104266527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25597 LANE ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542412",
"telephone_number": "909-680-9190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25597 LANE ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542412",
"telephone_number": "909-680-9190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBRAHIMI",
"first_name": "HAMID",
"middle_name": "REZA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-29",
"last_updated": "2013-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62499",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "62499",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.