Individual provider Active NPI

Pooya Soltanzadeh

  • Prosthodontics
  • Anaheim, CA
National Provider Identifier
1992251516
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
102464 Issued in CA
Practice address
8101 E Kaiser Blvd Ste 120
Anaheim, CA 92808-2261
Phone
(714) 974-0949
Fax
(714) 974-1310
NPI assigned
Sep 1, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Prosthodontics 1223P0700X 102464 CA Primary

Addresses

Primary practice location

8101 E Kaiser Blvd Ste 120
Anaheim, CA 92808-2261

Mailing address

8101 E Kaiser Blvd Ste 120
Anaheim, CA 92808-2261
Phone (714) 974-0949

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

LicenseStateTypeSpecialty
102464CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pooya Soltanzadeh, DDS, Ms Inc. CurrentSince Oct 10, 2021 Accepting new patients

Locations

8101 E Kaiser Blvd
Ste 120
Anaheim, CA 92808
Phone (424) 603-8394

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1992251516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8101 E KAISER BLVD STE 120",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928082261",
            "telephone_number": "714-974-0949",
            "fax_number": "714-974-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 E KAISER BLVD STE 120",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928082261",
            "telephone_number": "714-974-0949",
            "fax_number": "714-974-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLTANZADEH",
        "first_name": "POOYA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "102464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.