NPIMap

Organization Active NPI

Kambiz Mahdavi, DDS, a Professional Dental Corporation

  • Dentist
  • Thousand Oaks, CA
National Provider Identifier
1124248091
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
52639 Issued in CA
Legal business name
KAMBIZ MAHDAVI, DDS, A PROFESSIONAL DENTAL CORPORATION
Practice address
2875 E Thousand Oaks Blvd
Thousand Oaks, CA 91362-3202
Phone
(805) 496-2200
Fax
(805) 496-2225
NPI assigned
Apr 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Authorized official

Name
Dr. Kambiz Mahdavi, DDSNPI 1255448049
Title
President
Phone
(805) 496-2200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 52639 CA Primary

Addresses

Primary practice location

2875 E Thousand Oaks Blvd
Thousand Oaks, CA 91362-3202

Mailing address

2875 E Thousand Oaks Blvd
Thousand Oaks, CA 91362-3202
Phone (805) 496-2200

Other names 1

  • Skyline Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2875 E Thousand Oaks Blvd
Thousand Oaks, CA 91362
Phone (805) 496-2200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1124248091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 E THOUSAND OAKS BLVD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913623202",
            "telephone_number": "805-496-2200",
            "fax_number": "805-496-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 E THOUSAND OAKS BLVD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913623202",
            "telephone_number": "805-496-2200",
            "fax_number": "805-496-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAMBIZ MAHDAVI, DDS, A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "MAHDAVI",
        "authorized_official_first_name": "KAMBIZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-496-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "52639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.