Individual provider Active NPI

Niosha Vakilian, DDS

  • Dentist
  • Northridge, CA
National Provider Identifier
1205291671
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
64688 Issued in CA
Practice address
18450 Dearborn St
Northridge, CA 91325-2259
Phone
(818) 736-9339
NPI assigned
Dec 29, 2015
Last updated
Aug 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 64688 CA Primary
General Practice Dentistry 1223G0001X 33764 TX

Addresses

Primary practice location

18450 Dearborn St
Northridge, CA 91325-2259

Mailing address

19737 Crystal Hills LN
Northridge, CA 91326
Phone (818) 876-2947

Other practice location 1

2131 N Collins St Ste 415
Arlington, TX 76011-2811
Phone (817) 801-1382

Other practice location 2

1425 N 0'Connor Rd
irving, TX 75061
Phone (214) 492-1171

Other practice location 3

13431 Telegraph Rd
Whittier, CA 90605-3435
Phone (562) 946-2838

Other practice location 4

5006 Wesley St
Greenville, TX 75402-6307
Phone (903) 454-2336

Other identifiers 1

IdentifierTypeStateIssuer
1205291671MedicaidCA

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
I20160113001770 CA Order and Referring Only - DentistPractitioner - Dentist 9830491471

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
64688CAMDDentist
33764TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Niosha Vakilian Dental Group, Inc Current Accepting new patients
Edalat Dental Group, Apc CurrentSince Aug 7, 2022 Accepting new patients
Novasmile Dental PLLC General Practice Current Accepting new patients
Sorour D.M.D P,C Dentist PastSince Aug 7, 2022 Accepting new patients
Saman Edalat DDS Inc. Dentist Past Accepting new patients

Locations

18450 Dearborn St
Northridge, CA 91325
Phone (310) 999-9669

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1205291671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19737 CRYSTAL HILLS LN",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91326",
            "telephone_number": "818-876-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18450 DEARBORN ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913252259",
            "telephone_number": "818-736-9339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2131 N Collins St Ste 415",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760112811",
            "country_code": "US",
            "telephone_number": "817-801-1382",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1425 N 0'Connor Rd",
            "address_purpose": "LOCATION",
            "city": "irving",
            "state": "TX",
            "postal_code": "75061",
            "country_code": "US",
            "telephone_number": "214-492-1171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13431 Telegraph Rd",
            "address_purpose": "LOCATION",
            "city": "Whittier",
            "state": "CA",
            "postal_code": "906053435",
            "country_code": "US",
            "telephone_number": "562-946-2838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5006 Wesley St",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "TX",
            "postal_code": "754026307",
            "country_code": "US",
            "telephone_number": "903-454-2336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAKILIAN",
        "first_name": "NIOSHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-29",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64688",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "33764",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205291671",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.