Mehran Fotovatjah, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

41173 Issued in CA

Practice address

1805 El Camino Road
Suite 201
Palo Alto, CA 94326

Phone

(650) 328-1860

Fax

(650) 329-7950

NPI assigned

Mar 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 4, 2016 through Apr 4, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shih & Olsen GP

  • Endodontics
  • Atherton, CA
  • NPI 1568597540
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1619094240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 EL CAMINO ROAD",
            "address_2": "SUITE 201",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "94326",
            "telephone_number": "650-328-1860",
            "fax_number": "650-329-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 EL CAMINO ROAD",
            "address_2": "SUITE 201",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "94326",
            "telephone_number": "650-328-1860",
            "fax_number": "650-329-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTOVATJAH",
        "first_name": "MEHRAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "41173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Forsyth, MD
• Craig Forte, LCSW
• Evelyn Fortgang
• Jordan Foster, NP
• Michele Brown Foster, NP
• Found
• Cedar J Fowler, MD
• Karlene Mireya Fox-Williams
• Danielle Jean Fox, PHARMD
• Elizabeth Anne Bozaan Fox, MD

• Endodontics in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.