Active NPI
Maryam Mohamadi
- General Practice Dentistry
- San Luis Obispo, CA
National Provider Identifier
1982589222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 112185
- Practice address
- 3870 Broad St Ste 1
San Luis Obispo, CA 93401-7172 - Phone
- (805) 309-0467
- NPI assigned
- Aug 6, 2025
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 112185 | CA | Primary |
Addresses
Primary practice location
3870 Broad St Ste 1
San Luis Obispo, CA 93401-7172
Mailing address
1889 Vicente Dr
San Luis Obispo, CA 93405-6856
Phone (805) 215-4703
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 |
|---|---|---|---|
| 112185 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754438400000",
"number": "1982589222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1889 VICENTE DR",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934056856",
"telephone_number": "805-215-4703"
},
{
"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": "805-309-0467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMADI",
"first_name": "MARYAM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-06",
"last_updated": "2025-08-06",
"certification_date": "2025-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "112185",
"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 Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.