Active NPI
Sudabeh Z Moavenian, DDS, MS
- Periodontics
- Fremont, CA
National Provider Identifier
1528156809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 38333
- Practice address
- 39340 Fremont Blvd
Fremont, CA 94538-1320 - Phone
- (510) 739-3889
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 38333 | CA | Primary |
Addresses
Primary practice location
39340 Fremont Blvd
Fremont, CA 94538-1320
Mailing address
100 Bahama CT
San Ramon, CA 94582-1403
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
| License | State | Type | Specialty |
|---|---|---|---|
| 38333 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528156809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BAHAMA CT",
"city": "SAN RAMON",
"state": "CA",
"postal_code": "945821403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39340 FREMONT BLVD",
"city": "FREMONT",
"state": "CA",
"postal_code": "945381320",
"telephone_number": "510-739-3889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOAVENIAN",
"first_name": "SUDABEH",
"middle_name": "Z",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "38333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
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.