Active NPI
Shapour Etemadzadeh, R.D.H.
- Dental Hygienist
- San Diego, CA
National Provider Identifier
1891941597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- RDH 15077
- Practice address
- 3490 Palm Ave
San Diego, CA 92154 - Phone
- (619) 423-1351
- Fax
- (619) 423-1407
- NPI assigned
- Aug 13, 2008
- Sex
- Male
- 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 Hygienist | 124Q00000X | RDH 15077 | CA | Primary |
Addresses
Primary practice location
3490 Palm Ave
San Diego, CA 92154
Mailing address
3490 Palm Ave
San Diego, CA 92154
Phone (619) 423-1351
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 |
|---|---|---|---|
| RDH 15077 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218585600000",
"number": "1891941597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3490 PALM AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92154",
"telephone_number": "619-423-1351",
"fax_number": "619-423-1407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3490 PALM AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92154",
"telephone_number": "619-423-1351",
"fax_number": "619-423-1407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETEMADZADEH",
"first_name": "SHAPOUR",
"credential": "R.D.H.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-13",
"last_updated": "2008-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "RDH 15077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.