NPIMap

Individual provider Active NPI

Pooyan Nasibi, DDS

  • Pediatric Dentistry
  • Los Angeles, CA
National Provider Identifier
1457735565
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
63152 Issued in CA
Practice address
1835 S Bentley Ave Apt 6
Los Angeles, CA 90025-4324
Phone
(424) 208-4055
NPI assigned
Jul 17, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 63152 CA Primary

Addresses

Primary practice location

1835 S Bentley Ave Apt 6
Los Angeles, CA 90025-4324

Mailing address

1835 S Bentley Ave Apt 6
Los Angeles, CA 90025-4324
Phone (424) 208-4055

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pooyan Nasibi DDS Inc Pediatric Dentistry Current Accepting new patients
Pooyan Nasibi Dental Inc Pediatric Dentistry Current Accepting new patients

Organizations & group practices 2

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": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1457735565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 S BENTLEY AVE APT 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900254324",
            "telephone_number": "424-208-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 S BENTLEY AVE APT 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900254324",
            "telephone_number": "424-208-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASIBI",
        "first_name": "POOYAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "63152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.