Behtash Adibi

Primary specialty

DentistTaxonomy code 122300000X

License

107699 Issued in CA

Practice address

78595 Highway 111 Ste 300
La Quinta, CA 92253-2084

Phone

(607) 771-0300

NPI assigned

Jun 7, 2021

Last updated

Aug 5, 2022By 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 2

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

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1437726544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PASTO RICO # 34",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78595 HIGHWAY 111 STE 300",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922532084",
            "telephone_number": "607-771-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADIBI",
        "first_name": "BEHTASH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-07",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abayomi Adeyemi, M.D,S.C
• Ethan Abercrombie
• Marianna Abrahamyan
• Rezner H Abubakar
• Yomi A Adeyemi, M.D.
• Advanced Foot and Ankle Specialists, Inc.
• Aegis Group Practice LLC
• Aegis Group Practice, LLC
• Agl Ventures LLC (Majestic Residential Care)
• Angel Aguilar

• Dentist in La Quinta, CA
• Providers in La Quinta, CA by specialty
• Dentist in California

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

Verify at the official NPI Registry.