Siamak Afshar, D.D.S.

Key facts

NPI

1689718108

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

50717 (CA)

Practice address

11623 Cherry Ave
Suite B-2
Fontana, CA 92337-1212

Phone

(909) 355-1485

NPI assigned

Feb 16, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689718108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5712 LARRY DEAN ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928803150",
            "telephone_number": "909-923-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11623 CHERRY AVE",
            "address_2": "SUITE B-2",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923371212",
            "telephone_number": "909-355-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AFSHAR",
        "first_name": "SIAMAK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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