Individual provider Active NPI

Sasan Moghanjoghi Mokhtari, DDS

  • Student in an Organized Health Care Education/Training Program
  • Richmond, VA
National Provider Identifier
1972398832
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
0442000544 Issued in VA
Practice address
401 N 11TH St
Richmond, VA 23219-1901
Phone
(804) 828-0602
Fax
(804) 593-4279
NPI assigned
Apr 11, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0442000544 VA Primary

Addresses

Primary practice location

401 N 11TH St
Richmond, VA 23219-1901

Mailing address

PO Box 980257
Richmond, VA 23298-0257
Phone (804) 828-9783

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250820004988 VA Order and Referring Only - Maxillofacial SurgeryPractitioner - Maxillofacial Surgery 4688174089

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0442000544VAMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1972398832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 980257",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232980257",
            "telephone_number": "804-828-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N 11TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232191901",
            "telephone_number": "804-828-0602",
            "fax_number": "804-593-4279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOKHTARI",
        "first_name": "SASAN",
        "middle_name": "MOGHANJOGHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0442000544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.