Active NPI
Alex A. Pezeshkian, DMD
- Periodontics
- Cypress, CA
National Provider Identifier
1538332028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 34402
- Practice address
- 6101 Ball Rd Ste 310
Cypress, CA 90630-3966 - Phone
- (714) 220-9486
- Fax
- (714) 220-9481
- NPI assigned
- Apr 7, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 34402 | CA | Primary |
Addresses
Primary practice location
6101 Ball Rd Ste 310
Cypress, CA 90630-3966
Mailing address
6101 Ball Road. Ste. #310
Cypress, CA 90630
Phone (714) 220-9486
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 |
|---|---|---|---|---|
| I20200205001190 | CA | Practitioner - Oral Surgery | 0941542021 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34402 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207526400000",
"number": "1538332028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6101 BALL ROAD. STE. #310",
"city": "CYPRESS",
"state": "CA",
"postal_code": "90630",
"telephone_number": "714-220-9486",
"fax_number": "714-220-9481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6101 BALL RD STE 310",
"city": "CYPRESS",
"state": "CA",
"postal_code": "906303966",
"telephone_number": "714-220-9486",
"fax_number": "714-220-9481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEZESHKIAN",
"first_name": "ALEX",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-07",
"last_updated": "2008-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "34402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cypress, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; 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.