Active NPI
Wisam Mohammed Imran Al Janabi
- Dentist
- Sacramento, CA
National Provider Identifier
1316629660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 108980
- Practice address
- 1701 Watt Ave
Sacramento, CA 95825-2141 - Phone
- (916) 576-1900
- NPI assigned
- Aug 7, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | 108980 | CA | Primary |
Addresses
Primary practice location
1701 Watt Ave
Sacramento, CA 95825-2141
Mailing address
3911 Annadale LN
Sacramento, CA 95821-2040
Phone (619) 457-7128
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240904000328 | CA | Order and Referring Only - Dentist | 9537608625 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691366400000",
"number": "1316629660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3911 ANNADALE LN",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958212040",
"telephone_number": "619-457-7128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 WATT AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958252141",
"telephone_number": "916-576-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AL JANABI",
"first_name": "WISAM",
"middle_name": "MOHAMMED IMRAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-07",
"last_updated": "2023-08-07",
"certification_date": "2023-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "108980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.