Individual provider Active NPI

Golirz Ghiassi, DDS

  • General Practice Dentistry
  • San Rafael, CA
National Provider Identifier
1497710248
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
36924 Issued in CA
Practice address
712 D St
Suite I
San Rafael, CA 94901-3709
Phone
(415) 454-1267
Fax
(415) 339-8336
NPI assigned
Apr 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2008

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 36924 CA Primary

Addresses

Primary practice location

712 D St
Suite I
San Rafael, CA 94901-3709

Mailing address

712 D St
Suite I
San Rafael, CA 94901-3709
Phone (415) 454-1267

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

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1497710248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 D ST",
            "address_2": "SUITE I",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013709",
            "telephone_number": "415-454-1267",
            "fax_number": "415-339-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 D ST",
            "address_2": "SUITE I",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013709",
            "telephone_number": "415-454-1267",
            "fax_number": "415-339-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHIASSI",
        "first_name": "GOLIRZ",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-17",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.