Individual provider Active NPI

Elisha Haykani, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tarzana, CA
National Provider Identifier
1104714682
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DDS109873 Issued in CA
Practice address
18232 Weddington St
Tarzana, CA 91356-3620
Phone
(310) 414-7703
NPI assigned
Jun 25, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DDS109873 CA Primary

Addresses

Primary practice location

18232 Weddington St
Tarzana, CA 91356-3620

Mailing address

18232 Weddington St
Tarzana, CA 91356-3620
Phone (310) 414-7703

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250924003915 CA Order and Referring Only - Orthodontics and Dentofacial OrthopedicsPractitioner - Orthodontics and Dentofacial Orthopedics 4486159043

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS109873CAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1750809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1104714682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18232 WEDDINGTON ST",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563620",
            "telephone_number": "310-414-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18232 WEDDINGTON ST",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913563620",
            "telephone_number": "310-414-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYKANI",
        "first_name": "ELISHA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-25",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "DDS109873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

Verify at the official NPI Registry.