Active NPI
Javad Haydari
- General Practice Dentistry
- Bloomington, CA
National Provider Identifier
1427735539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 109171
- Practice address
- 17644 Valley Blvd Ste 1
Bloomington, CA 92316-3908 - Phone
- (909) 328-6787
- NPI assigned
- Jun 30, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 109171 | CA | Primary |
Addresses
Primary practice location
17644 Valley Blvd Ste 1
Bloomington, CA 92316-3908
Mailing address
9350 The Resort Pkwy Unit 1513
Rancho Cucamonga, CA 91730-9221
Phone (720) 412-8347
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 |
|---|---|---|---|
| 109171 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728432000000",
"number": "1427735539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9350 THE RESORT PKWY UNIT 1513",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917309221",
"telephone_number": "720-412-8347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17644 VALLEY BLVD STE 1",
"city": "BLOOMINGTON",
"state": "CA",
"postal_code": "923163908",
"telephone_number": "909-328-6787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYDARI",
"first_name": "JAVAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-30",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "109171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.