Yuriy Fatakhov, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

050629 Issued in NY

Practice address

10333 Queens Blvd
Forest Hills, NY 11375-3448

Phone

(718) 897-6300

Fax

(718) 897-5558

NPI assigned

Mar 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023140407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10333 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753448",
            "telephone_number": "718-897-6300",
            "fax_number": "718-897-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10333 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753448",
            "telephone_number": "718-897-6300",
            "fax_number": "718-897-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATAKHOV",
        "first_name": "YURIY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "050629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02561484",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tenille D Faria
• Faris Al-Gebory MD
• Patricia Farley, LMSW
• Daksha P Fata, RPH
• Francis L Fata, RPH
• Elona Fatakhova, DDS
• Rozaliya Fatakhova, DDS
• Ezro Fattakhov, DDS
• Igor Fattakhov
• Ruben Fattakhov, DDS

• Dentist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Dentist in New York

• 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.