Active NPI
Yervand Matevosyan
- Dental Hygienist
- Antelope, CA
National Provider Identifier
1679965537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 562
- Practice address
- 7749 Agate Beach Way
Antelope, CA 95843-6036 - Phone
- (916) 844-4004
- NPI assigned
- Mar 2, 2015
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 562 | CA | Primary |
Addresses
Primary practice location
7749 Agate Beach Way
Antelope, CA 95843-6036
Mailing address
7749 Agate Beach Way
Antelope, CA 95843-6036
Phone (916) 844-4004
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 |
|---|---|---|---|
| 562 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425254400000",
"number": "1679965537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7749 AGATE BEACH WAY",
"city": "ANTELOPE",
"state": "CA",
"postal_code": "958436036",
"telephone_number": "916-844-4004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7749 AGATE BEACH WAY",
"city": "ANTELOPE",
"state": "CA",
"postal_code": "958436036",
"telephone_number": "916-844-4004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATEVOSYAN",
"first_name": "YERVAND",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-02",
"last_updated": "2015-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antelope, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.