Active NPI
Farnam Ahmadi Moshtaghin
- Dentist
- San Luis Obispo, CA
National Provider Identifier
1972142040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104741
- Practice address
- 3870 Broad St Ste 1
San Luis Obispo, CA 93401-7172 - Phone
- (805) 214-4071
- NPI assigned
- Jan 6, 2020
- Last updated
- Jan 6, 2020
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 104741 | CA | Primary |
Addresses
Primary practice location
3870 Broad St Ste 1
San Luis Obispo, CA 93401-7172
Mailing address
17145 SW Oak St
Beaverton, OR 97007-3920
Phone (503) 962-9182
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 |
|---|---|---|---|
| 104741 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1972142040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17145 SW OAK ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970073920",
"telephone_number": "503-962-9182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3870 BROAD ST STE 1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934017172",
"telephone_number": "805-214-4071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMADI MOSHTAGHIN",
"first_name": "FARNAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-06",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.