Bevan Shoghi Fareid, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

64702 Issued in CA

Practice address

1591 Earl St
Kingsburg, CA 93631-2200

Phone

(559) 897-5042

NPI assigned

Sep 3, 2015

Last updated

Sep 3, 2015By the provider in NPPES

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

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1225406515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1591 EARL ST",
            "city": "KINGSBURG",
            "state": "CA",
            "postal_code": "936312200",
            "telephone_number": "559-897-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1591 EARL ST",
            "city": "KINGSBURG",
            "state": "CA",
            "postal_code": "936312200",
            "telephone_number": "559-897-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAREID",
        "first_name": "BEVAN",
        "middle_name": "SHOGHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "64702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell David Elkins, MPT
• Denise Hope Essman, PTA
• Destiny Danielle Estrada
• Hiliary A Fantasia, OT
• Behzad Mazda Fareid, DDS
• Neikka May Fareid, DDS
• Tina Marie Floyd, RDHAP
• Jennifer Elizabeth Fox, CFY-SLP
• Tanja Fridolfs, LMFT
• Jose Raul Garcia Jimenez

• General Practice Dentistry in Kingsburg, CA
• Providers in Kingsburg, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; 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.