Active NPI
Neema Behzad Mehrkhodavandi, DDS
- Endodontics
- San Francisco, CA
National Provider Identifier
1205177185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 62035
- Practice address
- 500 Spruce St
Suite 204
San Francisco, CA 94118-2666 - Phone
- (415) 221-1788
- NPI assigned
- Mar 2, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1856090 | MA | |
| Dentist | 122300000X | 62035 | CA | |
| Endodontics | 1223E0200X | 62035 | CA | Primary |
Addresses
Primary practice location
500 Spruce St
Suite 204
San Francisco, CA 94118-2666
Mailing address
500 Spruce St
Suite 204
San Francisco, CA 94118-2666
Phone (415) 221-1788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 11, 2015 through Sep 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1856090 | MA | MD | Dentist |
| 62035 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Polly Chan DDS Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Foster City, CA
- NPI 1508931247
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401753600000",
"number": "1205177185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SPRUCE ST",
"address_2": "SUITE 204",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941182666",
"telephone_number": "415-221-1788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SPRUCE ST",
"address_2": "SUITE 204",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941182666",
"telephone_number": "415-221-1788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHRKHODAVANDI",
"first_name": "NEEMA",
"middle_name": "BEHZAD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-02",
"last_updated": "2014-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1856090",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62035",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "62035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.