Hassan Adabi

Key facts

NPI

1104484476

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Dentistry 1223P0221X

License

0401418327 (VA)

Practice address

19301 Winmeade Dr Ste 202
Leesburg, VA 20176-6503

Phone

(703) 687-6769

NPI assigned

Jun 3, 2019

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 9, 2024.

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717891200000",
    "number": "1104484476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19301 WINMEADE DR STE 202",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201766503",
            "telephone_number": "703-687-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19301 WINMEADE DR STE 202",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201766503",
            "telephone_number": "703-687-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADABI",
        "first_name": "HASSAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2024-06-09",
        "certification_date": "2024-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24167",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401418327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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