Individual provider Active NPI

Elena Afsaneh Yeganeh-Tajian, DDS

  • Dentist
  • Beverly Hills, CA
National Provider Identifier
1700159050
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
61111 Issued in CA
Practice address
121 N Almont Dr Apt 301
Beverly Hills, CA 90211-1862
Phone
(310) 903-1403
NPI assigned
Feb 16, 2012
Last updated
Apr 27, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61111 CA Primary

Addresses

Primary practice location

121 N Almont Dr Apt 301
Beverly Hills, CA 90211-1862

Mailing address

121 N Almont Dr Apt 301
Beverly Hills, CA 90211-1862
Phone (310) 903-1403

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201009001151 CA Practitioner - Oral SurgeryPractitioner - Dentist 0244650414

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61111CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
John Cohen D D S Dental Corporation CurrentSince Aug 1, 2020 Accepting new patients
John Cohen D D S Dental Corporation Dentist Past Accepting new patients

Locations

10823 Hawthorne Blvd
Ste A
Inglewood, CA 90304
Phone (310) 412-8013

104 W Anaheim St
Ste C
Wilmington, CA 90744
Phone (310) 830-3452

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1700159050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N ALMONT DR APT 301",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111862",
            "telephone_number": "310-903-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N ALMONT DR APT 301",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111862",
            "telephone_number": "310-903-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEGANEH-TAJIAN",
        "first_name": "ELENA",
        "middle_name": "AFSANEH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-16",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.