Kambiz Mahdavi, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D52639 Issued in CA

Practice address

2875 E Thousand Oaks Blvd
Thousand Oaks, CA 91362-3202

Phone

(805) 496-2200

Fax

(805) 496-2225

NPI assigned

Aug 25, 2006

Last updated

Dec 4, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

State licenses

Practice roles

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.

• Kambiz Mahdavi, DDS, a Professional Dental Corporation

  dba Skyline Dental

  • Dentist
  • Thousand Oaks, CA
  • NPI 1124248091
  NPD (past) Authorized official

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1255448049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 E THOUSAND OAKS BLVD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913623202",
            "telephone_number": "805-496-2200",
            "fax_number": "805-496-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 E THOUSAND OAKS BLVD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913623202",
            "telephone_number": "805-496-2200",
            "fax_number": "805-496-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHDAVI",
        "first_name": "KAMBIZ",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "D52639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Lisette Madec, RBT
• Cuauhtemoc Magana, MD
• Georgina Constance Magana
• Tracy Dee Magnusson, PT
• Ajay Maharan
• Wendy Maher, MFT
• Taylor Ann Maholtz, CCC-SLP
• Mai Brooks MD a Medical Corporation
• Majid Golzari M D Inc. (West Oaks Urgent Care)
• Tara Makabi

• Dentist in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.