Active NPI
Keemia Shariati, DDS
- General Practice Dentistry
- Pinole, CA
National Provider Identifier
1982436994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 110594
- Practice address
- 806 San Pablo Ave Ste 1
Pinole, CA 94564-2479 - Phone
- (510) 974-0473
- NPI assigned
- Aug 19, 2024
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 110594 | CA | Primary |
Addresses
Primary practice location
806 San Pablo Ave Ste 1
Pinole, CA 94564-2479
Mailing address
1825 Countrywood CT
Walnut Creek, CA 94598-1013
Phone (925) 818-9326
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240918002842 | CA | Order and Referring Only - Dentist | 4284175241 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110594 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726272000000",
"number": "1982436994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 COUNTRYWOOD CT",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945981013",
"telephone_number": "925-818-9326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 SAN PABLO AVE STE 1",
"city": "PINOLE",
"state": "CA",
"postal_code": "945642479",
"telephone_number": "510-974-0473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHARIATI",
"first_name": "KEEMIA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-19",
"last_updated": "2024-09-14",
"certification_date": "2024-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "110594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinole, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.