Active NPI
Fartash Farkhondehkish, D.D.S., M.S.
- Periodontics
- Laguna Hills, CA
National Provider Identifier
1629102058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 52387
- Practice address
- 25283 Cabot Rd
Suite 111
Laguna Hills, CA 92653-5522 - Phone
- (949) 770-0548
- NPI assigned
- Mar 15, 2007
- 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 | 52387 | CA | Primary |
Addresses
Primary practice location
25283 Cabot Rd
Suite 111
Laguna Hills, CA 92653-5522
Mailing address
25283 Cabot Rd
Suite 111
Laguna Hills, CA 92653-5522
Phone (949) 770-0548
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 |
|---|---|---|---|---|
| I20160602002616 | CA | Order and Referring Only - Other (Physician) | 0042500027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629102058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25283 CABOT RD",
"address_2": "SUITE 111",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "926535522",
"telephone_number": "949-770-0548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25283 CABOT RD",
"address_2": "SUITE 111",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "926535522",
"telephone_number": "949-770-0548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARKHONDEHKISH",
"first_name": "FARTASH",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "52387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laguna Hills, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.