IndividualActive
Immanuel Selassie I
NPI 1053601039 · Dentist · Sacramento, CA
Immanuel Selassie I is a Dentist provider in Sacramento, CA (NPI 1053601039).
Provider details
- NPI number
- 1053601039
- Entity type
- Individual
- Primary specialty
- DentistDental Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 56829 (CA)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2430 Fair Oaks Blvd (apt 120)
Sacramento, CA 95825-5129
Phone: (206) 384-6915
Street-level locationGet directions
Mailing address
2322 Fruitvale Ave
Oakland, CA 94601-2534
Registry dates
- Enumerated
- 2011-04-12
- Last updated
- 2014-02-28
Frequently asked questions
- What is Immanuel Selassie I's NPI number?
- Immanuel Selassie I's National Provider Identifier (NPI) is 1053601039, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Immanuel Selassie I's specialty?
- Immanuel Selassie I is listed in the NPPES registry with a primary specialty of Dentist (Dental Providers).
- Where is Immanuel Selassie I located?
- Immanuel Selassie I's practice location on file with NPPES is 2430 Fair Oaks Blvd (apt 120), Sacramento, CA 95825-5129.
- What is Immanuel Selassie I's phone number?
- The practice phone number listed in the NPPES registry for Immanuel Selassie I is (206) 384-6915.
- Is Immanuel Selassie I's NPI active?
- Yes — Immanuel Selassie I's NPI (1053601039) is active in the NPPES registry as of the last update on 2014-02-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.