Active NPI
Mohsen Mir, DDS
- Dentist
- Pasadena, CA
National Provider Identifier
1639240856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 36396
- Practice address
- 903 E del Mar Blvd
Pasadena, CA 91106-3201 - Phone
- (626) 792-6195
- Fax
- (626) 792-8786
- NPI assigned
- Nov 10, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 36396 | CA | Primary |
Addresses
Primary practice location
903 E del Mar Blvd
Pasadena, CA 91106-3201
Mailing address
903 E del Mar Blvd
Pasadena, CA 91106-3201
Phone (626) 792-6195
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G91607-01 | Other | CA | DENTI-CAL PROVIDER NUMBER |
| B36396-01 | Other | CA | DENTICAL PROVIDR NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36396 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381190400000",
"number": "1639240856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 E DEL MAR BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911063201",
"telephone_number": "626-792-6195",
"fax_number": "626-792-8786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "903 E DEL MAR BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911063201",
"telephone_number": "626-792-6195",
"fax_number": "626-792-8786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIR",
"first_name": "MOHSEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-10",
"last_updated": "2013-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "36396",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL PROVIDER NUMBER",
"identifier": "G91607-01",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL PROVIDR NUMBER",
"identifier": "B36396-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.