Active NPI
Kelishadi Samani Dental Corp
- Dentist
- Carson, CA
National Provider Identifier
1508069576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 41930
- Legal business name
- KELISHADI SAMANI DENTAL CORP
- Practice address
- 23541 Avalon Blvd
Carson, CA 90745 - Phone
- (310) 830-3500
- Fax
- (310) 830-7994
- NPI assigned
- Jun 7, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marjan Kelishadi, DDS
- Title
- Dentist
- Phone
- (310) 830-3500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 41930 | CA | Primary |
Addresses
Primary practice location
23541 Avalon Blvd
Carson, CA 90745
Mailing address
23541 Avalon Blvd
Carson, CA 90745
Phone (310) 830-3500
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G9300701 | Medicaid | CA | |
| 809101 | Other | CA | UNITED CONCORDIA |
| 612331200 | Other | CA | AFFILIATED COMPUTER SERVI |
| G9805001 | Other | CA | HEALTHY FAMILIES |
National Provider Directory
National Provider DirectoryLocations
23541 Avalon Blvd
Carson, CA 90745
Phone (310) 830-3500
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Carson, CA
- NPI 1184882946
-
- General Practice Dentistry
- Los Angeles, CA
- NPI 1437206331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1215043200000",
"number": "1508069576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23541 AVALON BLVD",
"city": "CARSON",
"state": "CA",
"postal_code": "90745",
"telephone_number": "310-830-3500",
"fax_number": "310-830-7994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23541 AVALON BLVD",
"city": "CARSON",
"state": "CA",
"postal_code": "90745",
"telephone_number": "310-830-3500",
"fax_number": "310-830-7994"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KELISHADI SAMANI DENTAL CORP",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-07",
"last_updated": "2008-07-03",
"status": "A",
"authorized_official_last_name": "KELISHADI",
"authorized_official_first_name": "MARJAN",
"authorized_official_title_or_position": "DENTIST",
"authorized_official_telephone_number": "310-830-3500",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist",
"state": "CA",
"license": "41930",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G9300701",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "809101",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AFFILIATED COMPUTER SERVI",
"identifier": "612331200",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY FAMILIES",
"identifier": "G9805001",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.