Jonathan Marc Gidan, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

29280 Issued in CA

Practice address

12840 Riverside Dr
#504
North Hollywood, CA 91607-3327

Phone

(818) 506-2424

Fax

(818) 563-6789

NPI assigned

May 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164639803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12840 RIVERSIDE DR",
            "address_2": "#504",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073327",
            "telephone_number": "818-506-2424",
            "fax_number": "818-563-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12840 RIVERSIDE DR",
            "address_2": "#504",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073327",
            "telephone_number": "818-506-2424",
            "fax_number": "818-563-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIDAN",
        "first_name": "JONATHAN",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "29280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Ghazarian, PA
• Lilit Ghazaryan, OTA
• GHL Medical Supply
• Roozbeh Ghobadpour, L.A.C.
• Aram Ghorbani
• David Giella, PSYD
• Alexander Gilbert
• Lunda Lucinda Gill-Desbrow, M.F.T., ED.D.
• Miranda Gillmere
• Carly Gilmore, AMFT

• Pediatric Dentistry in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.