MEDICARE: NAVID MEHDIPOUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	108874	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629557996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVID MEHDIPOUR

Provider Business Mailing Address
First Line	:	1401 GUERNEVILLE RD STE 300
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-4174
Country	:	US
Telephone Number	:	707-800-8002
Fax Number	:	707-800-8004

Provider Business Practice Location Address
First Line	:	1401 GUERNEVILLE RD STE 300
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-4174
Country	:	US
Telephone Number	:	213-905-1073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	12/12/2025

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Directions to “ NAVID MEHDIPOUR ” Practice Location

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