Active NPI
Samon Nazemian
- Pediatric Dentistry
- Fairfax, VA
National Provider Identifier
1720640790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401416634
- Practice address
- 3700 Joseph Siewick Dr
Fairfax, VA 22033-1744 - Phone
- (703) 620-9122
- NPI assigned
- Jul 1, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 0401416634 | VA | Primary |
Addresses
Primary practice location
3700 Joseph Siewick Dr
Fairfax, VA 22033-1744
Mailing address
2822 Misty Pond CT
Oakton, VA 22124-1159
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 |
|---|---|---|---|
| 0401416634 | VA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629763200000",
"number": "1720640790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2822 MISTY POND CT",
"city": "OAKTON",
"state": "VA",
"postal_code": "221241159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 JOSEPH SIEWICK DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331744",
"telephone_number": "703-620-9122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAZEMIAN",
"first_name": "SAMON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-01",
"last_updated": "2021-08-24",
"certification_date": "2021-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401416634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.