Individual provider Active NPI

Kass Nourishad, D.D.S.

  • Dentist
  • Reseda, CA
National Provider Identifier
1104945252
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
38892 Issued in CA
Practice address
17703 Vanowen St
Reseda, CA 91335-5602
Phone
(818) 609-0009
Fax
(818) 609-1158
NPI assigned
Mar 28, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 38892 CA Primary

Addresses

Primary practice location

17703 Vanowen St
Reseda, CA 91335-5602

Mailing address

17703 Vanowen St
Reseda, CA 91335-5602
Phone (818) 609-0009

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140505002210 CA Practitioner - Oral SurgeryPractitioner - Diagnostic Radiology 7113150749

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
KH Nourishad Inc Dentist CurrentSince Oct 13, 2011 Accepting new patients

Locations

17703 Vanowen St
Reseda, CA 91335
Phone (818) 609-0009

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104945252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17703 VANOWEN ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355602",
            "telephone_number": "818-609-0009",
            "fax_number": "818-609-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17703 VANOWEN ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355602",
            "telephone_number": "818-609-0009",
            "fax_number": "818-609-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOURISHAD",
        "first_name": "KASS",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "38892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

Verify at the official NPI Registry.