Individual provider Active NPI

Sevetlana Shahnazarians

  • Dentist
  • Pasadena, CA
National Provider Identifier
1114181872
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
57036 Issued in CA
Practice address
859 N Fair Oaks Ave Ste 120
Pasadena, CA 91103-3078
Phone
(626) 765-9758
Fax
(626) 765-9760
NPI assigned
Jul 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 57036 CA Primary

Addresses

Primary practice location

859 N Fair Oaks Ave Ste 120
Pasadena, CA 91103-3078

Mailing address

859 N Fair Oaks Ave Ste 120
Pasadena, CA 91103-3078
Phone (626) 765-9758

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
I20180430002637 CA Order and Referring Only - DentistPractitioner - Dentist 6204190192

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
57036CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
S Shahnazarians DDS a Professional Corp PastSince Jul 24, 2022 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1114181872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 N FAIR OAKS AVE STE 120",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911033078",
            "telephone_number": "626-765-9758",
            "fax_number": "626-765-9760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 N FAIR OAKS AVE STE 120",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911033078",
            "telephone_number": "626-765-9758",
            "fax_number": "626-765-9760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHNAZARIANS",
        "first_name": "SEVETLANA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.