Individual provider Active NPI

Mojtaba Golestan, DDS

  • General Practice Dentistry
  • Sacramento, CA
National Provider Identifier
1790977510
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
55975 Issued in CA
Practice address
2020 Hurley Way Ste 135
Sacramento, CA 95825-5143
Phone
(412) 580-5811
Fax
(916) 641-7702
NPI assigned
Aug 15, 2007
Last updated
Jan 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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 55975 CA Primary

Addresses

Primary practice location

2020 Hurley Way Ste 135
Sacramento, CA 95825-5143

Mailing address

2020 Hurley Way Ste 135
Sacramento, CA 95825-3298
Phone (916) 641-7700

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

Practice roles

OrganizationSpecialtyStatusNew patients
M. Golestan DDS Inc Past Accepting new patients

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, 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": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1790977510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 HURLEY WAY STE 135",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958253298",
            "telephone_number": "916-641-7700",
            "fax_number": "916-641-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 HURLEY WAY STE 135",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958255143",
            "telephone_number": "412-580-5811",
            "fax_number": "916-641-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLESTAN",
        "first_name": "MOJTABA",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-15",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.