Individual provider Active NPI

Rojin Amiri

  • Pediatric Dentistry
  • San Jose, CA
National Provider Identifier
1285012344
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
100533 Issued in CA
Practice address
4155 Moorpark Ave Ste 10
San Jose, CA 95117-1714
Phone
(408) 585-9494
Fax
(408) 247-1875
NPI assigned
May 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 100533 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X LDR180199 IN
Dentist 122300000X 100533 CA

Addresses

Primary practice location

4155 Moorpark Ave Ste 10
San Jose, CA 95117-1714

Mailing address

4155 Moorpark Ave Ste 10
San Jose, CA 95117-1714

Other practice location 1

6245 N Fresno St
Suite 103
Fresno, CA 93710-5270
Phone (559) 554-9999

Other practice location 2

1127 S St
Fresno, CA 93721-1408
Phone (559) 554-9999

Other practice location 3

705 Riley Hospital Dr Ste 4205
Indianapolis, IN 46202
Phone (317) 944-9604

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
100533CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rojin Amiri DDS Inc Pediatric Dentistry CurrentSince Jun 27, 2021 Accepting new patients
Children's Dentistry and Orthodontics of Fresno a Dental Office of Ste PastSince Mar 1, 2020 Accepting new patients
University Pediatric Dentistry Associates Pediatric Dentistry Past Accepting new patients

Locations

4155 Moorpark Ave
Ste 10
San Jose, CA 95117
Phone (408) 410-5398

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1431129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1285012344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4155 MOORPARK AVE STE 10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951171714",
            "fax_number": "408-247-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 MOORPARK AVE STE 10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951171714",
            "telephone_number": "408-585-9494",
            "fax_number": "408-247-1875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6245 N Fresno St",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937105270",
            "country_code": "US",
            "telephone_number": "559-554-9999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1127 S St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937211408",
            "country_code": "US",
            "telephone_number": "559-554-9999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 Riley Hospital Dr Ste 4205",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "46202",
            "country_code": "US",
            "telephone_number": "317-944-9604",
            "fax_number": "317-948-0760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMIRI",
        "first_name": "ROJIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-09",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "100533",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "LDR180199",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100533",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.

Verify at the official NPI Registry.