Individual provider Active NPI

Bahram Shahangian, D.D.S.

  • Dentist
  • North Hollywood, CA
National Provider Identifier
1952513608
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
44083 Issued in CA
Practice address
4821 Lankershim Blvd
Suite B
North Hollywood, CA 91601-4538
Phone
(818) 508-7300
Fax
(818) 766-9755
NPI assigned
May 4, 2007
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 44083 CA Primary

Addresses

Primary practice location

4821 Lankershim Blvd
Suite B
North Hollywood, CA 91601-4538

Mailing address

4821 Lankershim Blvd
Suite B
North Hollywood, CA 91601-4538
Phone (818) 508-7300

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241105002766 CA Practitioner - Dentist 0244471811 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blessing Community Health Center CurrentSince Nov 8, 2024 Accepting new patients
Blessing Community Health Center CurrentSince Nov 8, 2024 Accepting new patients
Shahangian Dental Corp. PastSince Aug 8, 2021 Accepting new patients

Locations

3972 N Waterman Ave
Ste 104
San Bernardino, CA 92404
Phone (909) 433-9700

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Blessing Community Health CenterSan Bernardino, CA, CCN A01869 Federally qualified health center Corporate Officer (50%)
W-2 Managing Employee
Oct 1, 2021
Oct 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1952513608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4821 LANKERSHIM BLVD",
            "address_2": "SUITE B",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916014538",
            "telephone_number": "818-508-7300",
            "fax_number": "818-766-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4821 LANKERSHIM BLVD",
            "address_2": "SUITE B",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916014538",
            "telephone_number": "818-508-7300",
            "fax_number": "818-766-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHANGIAN",
        "first_name": "BAHRAM",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "44083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Hollywood, CA

Sources for this page

Verify at the official NPI Registry.