Active NPI
Mahnaz Yazdanmanesh
- Dentist
- Los Angeles, CA
National Provider Identifier
1912782244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 64461
- Practice address
- 2995 N Beverly Glen Cir
Los Angeles, CA 90077-1705 - Phone
- (310) 508-9202
- NPI assigned
- Aug 25, 2023
- Last updated
- Aug 25, 2023
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 64461 | CA | Primary |
Addresses
Primary practice location
2995 N Beverly Glen Cir
Los Angeles, CA 90077-1705
Mailing address
2995 N Beverly Glen Cir
Los Angeles, CA 90077-1705
Phone (310) 508-9202
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 |
|---|---|---|---|
| 64461 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692921600000",
"number": "1912782244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2995 N BEVERLY GLEN CIR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900771705",
"telephone_number": "310-508-9202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2995 N BEVERLY GLEN CIR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900771705",
"telephone_number": "310-508-9202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAZDANMANESH",
"first_name": "MAHNAZ",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-25",
"last_updated": "2023-08-25",
"certification_date": "2023-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "64461",
"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 Aug 25, 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.