Active NPI
Sean Moghadam
- Oral and Maxillofacial Surgery (Dentist)
- Fullerton, CA
National Provider Identifier
1174074199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 107536
- Practice address
- 1620 S Harbor Blvd
Fullerton, CA 92832-3473 - Phone
- (714) 294-7070
- NPI assigned
- Oct 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 107536 | CA | Primary |
Addresses
Primary practice location
1620 S Harbor Blvd
Fullerton, CA 92832-3473
Mailing address
1620 S Harbor Blvd
Fullerton, CA 92832-3473
Phone (213) 222-5183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161122000266 | IL | Order and Referring Only - Oral Surgery | 5890074405 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107536 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756080000000",
"number": "1174074199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 S HARBOR BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323473",
"telephone_number": "213-222-5183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 S HARBOR BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323473",
"telephone_number": "714-294-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHADAM",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-14",
"last_updated": "2025-08-25",
"certification_date": "2025-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "107536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.