Individual provider Active NPI

Shokoufeh Yaseri, DDS

  • General Practice Dentistry
  • Vista, CA
National Provider Identifier
1760114474
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
107550 Issued in CA
Practice address
1350 E Vista Way Ste 10
Vista, CA 92084-4037
Phone
(760) 208-1173
NPI assigned
Jun 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 107550 CA
General Practice Dentistry 1223G0001X 107550 CA Primary

Addresses

Primary practice location

1350 E Vista Way Ste 10
Vista, CA 92084-4037

Mailing address

6447 Reflection Dr Apt 203
San Diego, CA 92124-3124
Phone (858) 308-9373

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
I20221130003077 CA Order and Referring Only - DentistPractitioner - Dentist 2062880750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ronny Le Dental Corporation Dentist CurrentSince Jul 3, 2022 Accepting new patients

Locations

1350 E Vista Way
Ste 10
Vista, CA 92084
Phone (760) 208-1173

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1760114474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6447 REFLECTION DR APT 203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243124",
            "telephone_number": "858-308-9373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E VISTA WAY STE 10",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920844037",
            "telephone_number": "760-208-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YASERI",
        "first_name": "SHOKOUFEH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107550",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.