Active NPI
Jad S Elkhoury, DDS, MS
- Periodontics
- Sonoma, CA
National Provider Identifier
1023109428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 52382
- Practice address
- 248 Perkins St
Sonoma, CA 95476 - Phone
- (707) 938-2155
- Fax
- (707) 935-2142
- NPI assigned
- Sep 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 52382 | CA | Primary |
Addresses
Primary practice location
248 Perkins St
Sonoma, CA 95476
Mailing address
248 Perkins St
Sonoma, CA 95476
Phone (707) 938-2155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 29, 2022 through Sep 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52382 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023109428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 PERKINS ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "95476",
"telephone_number": "707-938-2155",
"fax_number": "707-935-2142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 PERKINS ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "95476",
"telephone_number": "707-938-2155",
"fax_number": "707-935-2142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELKHOURY",
"first_name": "JAD",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "52382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sonoma, CA
- Clayton Franklyn Drake Jr., MD
- Susan Dunlop, RN
- Brett James Dupont, DPM
- Dupontdpm Inc. (Golden Gate Foot and Ankle)
- Mari-Lynne Earls, LMFT
- Russell Marc Elmer, MD
- Ensign Sonoma LLC (Broadway Villa Post Acute)
- Joseph Ercolini, DC
- John Williams Evans, MD
- Eye Associates of Northern California Medical Group Inc. (Mark Schluter MD and Sophia Schluter MD)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.