Active NPI
Nana Avetisyan
- Dental Assistant
- Van Nuys, CA
National Provider Identifier
1891309233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- RDA94891
- Practice address
- 13716 Sherman Way
Van Nuys, CA 91405-2626 - Phone
- (818) 744-5102
- NPI assigned
- Sep 2, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | RDA94891 | CA | Primary |
Addresses
Primary practice location
13716 Sherman Way
Van Nuys, CA 91405-2626
Mailing address
7015 Fulton Ave Apt 5
North Hollywood, CA 91605-4424
Phone (818) 744-5102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RDA94891 | Medicaid | CA |
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 |
|---|---|---|---|
| RDA94891 | CA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1891309233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7015 FULTON AVE APT 5",
"city": "NORTH HOLLYWOOD",
"state": "CA",
"postal_code": "916054424",
"telephone_number": "818-744-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13716 SHERMAN WAY",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914052626",
"telephone_number": "818-744-5102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVETISYAN",
"first_name": "NANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-02",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "RDA94891",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "RDA94891",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.