Individual provider Active NPI

Amir Dadgar-Yeganeh, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • San Jose, CA
National Provider Identifier
1609285691
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
62830 Issued in CA
Practice address
3030 Alum Rock Ave
San Jose, CA 95127-2807
Phone
(310) 774-1372
NPI assigned
Aug 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 62830 CA
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 62830 CA Primary

Addresses

Primary practice location

3030 Alum Rock Ave
San Jose, CA 95127-2807

Mailing address

1026 Noriega St
San Francisco, CA 94122-4514

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amir.dadgaryegenah.p1@direct.eisnerhealth.nextgenshare.com Health Information Exchange (HIE)

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170523002449 CA Order and Referring Only - DentistPractitioner - Dentist 8921375957

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
62830CAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1609285691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 NORIEGA ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941224514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 ALUM ROCK AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951272807",
            "telephone_number": "310-774-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DADGAR-YEGANEH",
        "first_name": "AMIR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-05",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62830",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "62830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amir.dadgaryegenah.p1@direct.eisnerhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGenShare, Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1530 S Olive St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900153023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.