Active NPI
Keivan Zoufan, DDS, MDS
- Endodontics
- Cupertino, CA
National Provider Identifier
1881608784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 52700
- Practice address
- 10055 Miller Ave
Suite 103
Cupertino, CA 95014-3472 - Phone
- (310) 592-0731
- NPI assigned
- Jul 28, 2006
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 000032 | NY | |
| General Practice Dentistry | 1223G0001X | 6120 | AZ | |
| General Practice Dentistry | 1223G0001X | 009797 | CT | |
| Endodontics | 1223E0200X | 009797 | CT | |
| Endodontics | 1223E0200X | 52700 | CA | Primary |
Addresses
Primary practice location
10055 Miller Ave
Suite 103
Cupertino, CA 95014-3472
Mailing address
10055 Miller Ave
Suite 103
Cupertino, CA 95014-3472
Phone (310) 592-0731
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02701531 | Medicaid | NY | |
| 9181534 | Other | NY | DORAL |
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 |
|---|---|---|---|
| 009797 | CT | MD | General Practice Dentistry |
| 000032 | NY | MD | Dance Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362355200000",
"number": "1881608784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10055 MILLER AVE",
"address_2": "SUITE 103",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "950143472",
"telephone_number": "310-592-0731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10055 MILLER AVE",
"address_2": "SUITE 103",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "950143472",
"telephone_number": "310-592-0731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZOUFAN",
"first_name": "KEIVAN",
"credential": "DDS, MDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2013-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "000032",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "6120",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "009797",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CT",
"license": "009797",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "52700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02701531",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL",
"identifier": "9181534",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cupertino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.