Individual provider Active NPI

Abraham Ghorbanian, DDS, MS

  • General Practice Dentistry
  • Bellevue, WA
National Provider Identifier
1447325071
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE8183 Issued in WA
Practice address
1200 112TH Ave NE
Suite C-222
Bellevue, WA 98004-3732
Phone
(425) 450-9500
Fax
(425) 450-5008
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE8183 WA Primary

Addresses

Primary practice location

1200 112TH Ave NE
Suite C-222
Bellevue, WA 98004-3732

Mailing address

1200 112TH Ave NE
Suite C-222
Bellevue, WA 98004-3732
Phone (425) 450-9500

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
DE8183WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sahli Ghorbanian PLLC Current Accepting new patients
Mahroo Sabeti Ghorbanian Dental Corp Current Accepting new patients
Hwang Ghorbanian Im II DDS PS General Practice PastSince Jul 27, 2020 Accepting new patients
Edward Im DDS PS Past Accepting new patients

Locations

10001 Indiana Ave
Ste 101
Riverside, CA 92503

10001 Indiana Ave
Riverside, CA 92503
Phone (909) 689-0701

300 E 7th St
Ste 2G
Upland, CA 91786
Phone (909) 526-1914

111 SE Everett Mall Way
Ste B101
Everett, WA 98208
Phone (425) 565-1872

Organizations & group practices 4

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447325071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE",
            "address_2": "SUITE C-222",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043732",
            "telephone_number": "425-450-9500",
            "fax_number": "425-450-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE",
            "address_2": "SUITE C-222",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043732",
            "telephone_number": "425-450-9500",
            "fax_number": "425-450-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHORBANIAN",
        "first_name": "ABRAHAM",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE8183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.