Active NPI
Andia Ezzati
- General Practice Dentistry
- Encino, CA
National Provider Identifier
1457117152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 109836
- Practice address
- 5501 Newcastle Ave Apt 202
Encino, CA 91316-2176 - Phone
- (818) 277-9442
- NPI assigned
- Feb 21, 2024
- Sex
- Female
- 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 | 109836 | CA | Primary |
Addresses
Primary practice location
5501 Newcastle Ave Apt 202
Encino, CA 91316-2176
Mailing address
5501 Newcastle Ave Apt 202
Encino, CA 91316-2176
Phone (818) 277-9442
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 |
|---|---|---|---|---|
| I20240524001828 | CA | Order and Referring Only - Dentist | 0244672053 |
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": "1708473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1457117152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5501 NEWCASTLE AVE APT 202",
"city": "ENCINO",
"state": "CA",
"postal_code": "913162176",
"telephone_number": "818-277-9442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 NEWCASTLE AVE APT 202",
"city": "ENCINO",
"state": "CA",
"postal_code": "913162176",
"telephone_number": "818-277-9442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZZATI",
"first_name": "ANDIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-21",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "109836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.