NPIMap

Organization Active NPI

Pouyan, DDS and Khanideh, DDS, Inc.

  • General Practice Dentistry
  • Santa Monica, CA
National Provider Identifier
1780063594
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
POUYAN, DDS AND KHANIDEH, DDS, INC.
Practice address
2730 Wilshire Blvd
Suite 100
Santa Monica, CA 90403-4743
Phone
(310) 828-2440
Fax
(310) 828-0177
NPI assigned
May 26, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Authorized official

Name
Dr. Shabnam Khanideh, DMD
Title
Secretary
Phone
(310) 828-2440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X CA Primary

Addresses

Primary practice location

2730 Wilshire Blvd
Suite 100
Santa Monica, CA 90403-4743

Mailing address

2730 Wilshire Blvd
Suite 100
Santa Monica, CA 90403-4743
Phone (310) 828-2440

National Provider Directory

National Provider Directory

Locations

2730 Wilshire Blvd
Ste 100
Santa Monica, CA 90403
Phone (310) 828-2440

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1780063594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 WILSHIRE BLVD",
            "address_2": "SUITE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034743",
            "telephone_number": "310-828-2440",
            "fax_number": "310-828-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 WILSHIRE BLVD",
            "address_2": "SUITE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034743",
            "telephone_number": "310-828-2440",
            "fax_number": "310-828-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUYAN, DDS AND KHANIDEH, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "KHANIDEH",
        "authorized_official_first_name": "SHABNAM",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "310-828-2440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; 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.