Individual provider Active NPI

Maneli N/a Ardeshir Zadeh

  • Dentist
  • Irvine, CA
National Provider Identifier
1154108132
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
109390 Issued in CA
Practice address
22 Glenhurst
Irvine, CA 92604-3727
Phone
(949) 529-8412
NPI assigned
Sep 12, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109390 CA Primary

Addresses

Primary practice location

22 Glenhurst
Irvine, CA 92604-3727

Mailing address

22 Glenhurst
Irvine, CA 92604-3727
Phone (949) 529-8412

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
I20240130001797 CA Order and Referring Only - DentistPractitioner - Dentist 8022461755

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1154108132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 GLENHURST",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926043727",
            "telephone_number": "949-529-8412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 GLENHURST",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926043727",
            "telephone_number": "949-529-8412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARDESHIR ZADEH",
        "first_name": "MANELI",
        "middle_name": "N/A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.