Active NPI
Azadeh Ghavamnasiri
- Dentist
- Reseda, CA
National Provider Identifier
1225600281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS106375
- Practice address
- 18014 Sherman Way Apt 144
Reseda, CA 91335-4622 - Phone
- (949) 241-0095
- NPI assigned
- Jul 10, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DDS106375 | CA | Primary |
Addresses
Primary practice location
18014 Sherman Way Apt 144
Reseda, CA 91335-4622
Mailing address
18014 Sherman Way Apt 144
Reseda, CA 91335-4622
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | azadehbruin@g.ucla.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS106375 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625875200000",
"number": "1225600281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18014 SHERMAN WAY APT 144",
"city": "RESEDA",
"state": "CA",
"postal_code": "913354622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18014 SHERMAN WAY APT 144",
"city": "RESEDA",
"state": "CA",
"postal_code": "913354622",
"telephone_number": "949-241-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHAVAMNASIRI",
"first_name": "AZADEH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-10",
"last_updated": "2021-07-10",
"certification_date": "2021-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS106375",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "azadehbruin@g.ucla.edu",
"affiliation": "N",
"address_1": "18014 Sherman Way Apt 144",
"city": "Reseda",
"state": "CA",
"country_code": "US",
"postal_code": "913354622",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Reseda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.