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MEHRAN FOTOVATJAH DDS
NPI 1619094240
Dentist - Endodontics in Palo Alto, CA

Active since March 26, 2007Opted out of Medicare · through Apr 4, 2028
1805 EL CAMINO ROAD, SUITE 201, PALO ALTO, CA 94326(650) 328-1860(650) 329-7950 Get Directions Write a Review

NPPES record last updated: October 15, 2020. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Mehran Fotovatjah Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEHRAN FOTOVATJAH DDS (NPI 1619094240) is an individual endodontics provider in Palo Alto, California, licensed in California (41173) and active in the NPI registry since March 2007. He has opted out of Medicare through April 4, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1619094240
Entity TypeIndividualMale
Primary Taxonomy1223E0200X
Provider Legal NameMEHRAN FOTOVATJAHCredential: DDS
Location Address1805 EL CAMINO ROAD, SUITE 201Palo Alto, CA 94326
Mailing Address1805 El Camino Road, Suite 201Palo Alto, CA 94326 · (650) 328-1860 · Fax (650) 329-7950
Phone(650) 328-1860
Fax(650) 329-7950
Sole ProprietorNo
Enumeration DateMarch 26, 2007
Last NPPES UpdateOctober 15, 2020
NPPES CertifiedOctober 15, 2020
✔ NPI 1619094240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · EndodonticsDental Providers
Taxonomy Code1223E0200X
License✔ Licensed in CA · 41173
Definition
The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.
1805 EL CAMINO ROAD, Palo Alto, CA 94326
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Mehran Fotovatjah Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 4, 2016 through April 4, 2028.

Opt-Out Effective DateApril 4, 2016
Opt-Out In Effect ThroughApril 4, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mehran Fotovatjah's NPI number?

The NPI number for Mehran Fotovatjah is 1619094240. It was assigned to this individual provider in the NPPES registry on March 26, 2007.

Where is Mehran Fotovatjah located?

Mehran Fotovatjah practices at 1805 El Camino Road Suite 201, Palo Alto, CA 94326. The listed phone number is (650) 328-1860.

What is Mehran Fotovatjah's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Endodontics, with taxonomy code 1223E0200X.

Is Mehran Fotovatjah enrolled in Medicare?

No. Mehran Fotovatjah has opted out of Medicare through April 4, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mehran Fotovatjah was last updated on October 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.