Active NPI
Shirin Yezdi Bahadurji
- Dentist
- Culver City, CA
National Provider Identifier
1356939136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12013518A
- Practice address
- 3861 Sepulveda Blvd
Culver City, CA 90230-4605 - Phone
- (310) 806-1327
- NPI assigned
- Jan 6, 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 | 12013518A | IN | Primary |
Addresses
Primary practice location
3861 Sepulveda Blvd
Culver City, CA 90230-4605
Mailing address
888 Hilgard Ave Apt 110
Los Angeles, CA 90024-3184
Phone (310) 806-1327
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 |
|---|---|---|---|---|
| I20230920003281 | CA | Practitioner - Dentist | 0941654271 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013518A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Family Health Center | Current | Accepting new patients |
Locations
3861 Sepulveda Blvd
Culver City, CA 90230
Phone (310) 450-2191
1711 Ocean Park Blvd
Santa Monica, CA 90405
Phone (310) 450-2191
Organizations & group practices 1
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": "1609891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1356939136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "888 HILGARD AVE APT 110",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243184",
"telephone_number": "310-806-1327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3861 SEPULVEDA BLVD",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902304605",
"telephone_number": "310-806-1327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAHADURJI",
"first_name": "SHIRIN",
"middle_name": "YEZDI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-06",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12013518A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.