Individual provider Active NPI

Homa Shahriari, DENTIST

  • General Practice Dentistry
  • Northridge, CA
National Provider Identifier
1720204134
Registry record updated May 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
44258 Issued in CA
Practice address
8632 Balboa Blvd
Northridge, CA 91325-3505
Phone
(818) 894-6161
Fax
(818) 894-6001
NPI assigned
Apr 17, 2007
Last updated
May 24, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 44258 CA Primary

Addresses

Primary practice location

8632 Balboa Blvd
Northridge, CA 91325-3505

Mailing address

8632 Balboa Blvd
Northridge, CA 91325-3505
Phone (818) 894-6161

Other identifiers 2

IdentifierTypeStateIssuer
FHC70436FOtherCAMEDI-CAL NUMBER
B4425802OtherCAMEDI-CAL PROVIDER 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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shahriari DDS Inc PastSince Aug 12, 2015 Accepting new patients

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": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369353600000",
    "number": "1720204134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8632 BALBOA BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913253505",
            "telephone_number": "818-894-6161",
            "fax_number": "818-894-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8632 BALBOA BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913253505",
            "telephone_number": "818-894-6161",
            "fax_number": "818-894-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHRIARI",
        "first_name": "HOMA",
        "credential": "DENTIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2013-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL NUMBER",
            "identifier": "FHC70436F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "B4425802",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.

Verify at the official NPI Registry.