Active NPI
Andrea B Holstein, DMD
- Endodontics
- Los Angeles, CA
National Provider Identifier
1811260003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 48611
- Practice address
- 10921 Wilshire Blvd
Suite 807
Los Angeles, CA 90024-3906 - Phone
- (310) 209-5050
- Fax
- (310) 209-5550
- NPI assigned
- Feb 17, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 48611 | CA | Primary |
Addresses
Primary practice location
10921 Wilshire Blvd
Suite 807
Los Angeles, CA 90024-3906
Mailing address
3207 Fryman Rd
Studio City, CA 91604-4115
Phone (818) 761-8851
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170524002490 | CA | Order and Referring Only - Dentist | 7517234404 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48611 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eddie Harouni, D.D.S.,Inc. | Endodontics | 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.
-
- Endodontics
- Los Angeles, CA
- NPI 1033345525
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329436800000",
"number": "1811260003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3207 FRYMAN RD",
"city": "STUDIO CITY",
"state": "CA",
"postal_code": "916044115",
"telephone_number": "818-761-8851",
"fax_number": "818-761-8851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10921 WILSHIRE BLVD",
"address_2": "SUITE 807",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243906",
"telephone_number": "310-209-5050",
"fax_number": "310-209-5550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLSTEIN",
"first_name": "ANDREA",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-17",
"last_updated": "2012-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "48611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.