Active NPI
Edwin Jakob Pouldar, DDS
- Dentist
- Sherman Oaks, CA
National Provider Identifier
1801403886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 105565
- Practice address
- 14912 Burbank Blvd
Sherman Oaks, CA 91411-3609 - Phone
- (818) 909-0222
- NPI assigned
- Sep 24, 2020
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 105565 | CA | Primary |
Addresses
Primary practice location
14912 Burbank Blvd
Sherman Oaks, CA 91411-3609
Mailing address
14912 Burbank Blvd
Sherman Oaks, CA 91411-3609
Phone (818) 909-0222
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 |
|---|---|---|---|
| 105565 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pouldar Kimia and Lorenz Dental Partnership | 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 and National Provider Directory roles.
-
- General Practice Dentistry
- Sherman Oaks, CA
- NPI 1639624463
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699056000000",
"number": "1801403886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14912 BURBANK BLVD",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914113609",
"telephone_number": "818-909-0222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14912 BURBANK BLVD",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914113609",
"telephone_number": "818-909-0222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULDAR",
"first_name": "EDWIN",
"middle_name": "JAKOB",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-24",
"last_updated": "2023-11-04",
"certification_date": "2023-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "105565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.