Individual provider Active NPI

Rafi Balabanian, D.D.S.

  • General Practice Dentistry
  • Santa Clara, CA
National Provider Identifier
1174559025
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
38796 Issued in CA
Practice address
1961 Pruneridge Ave
Suite a
Santa Clara, CA 95050-6575
Phone
(408) 985-7234
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 38796 CA Primary

Addresses

Primary practice location

1961 Pruneridge Ave
Suite a
Santa Clara, CA 95050-6575

Mailing address

1961 Pruneridge Ave
Suite a
Santa Clara, CA 95050-6575
Phone (408) 985-7234

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160808002166 CA Order and Referring Only - Other (Non-Physician) 1850685249

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
38796CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174559025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1961 PRUNERIDGE AVE",
            "address_2": "SUITE A",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950506575",
            "telephone_number": "408-985-7234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 PRUNERIDGE AVE",
            "address_2": "SUITE A",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950506575",
            "telephone_number": "408-985-7234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALABANIAN",
        "first_name": "RAFI",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "38796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Clara, CA

Sources for this page

Verify at the official NPI Registry.