Yakov Khaydatov, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

7845 Issued in AZ

Practice address

5225 N 19TH Ave
Suite C
Phoenix, AZ 85015-2903

Phone

(602) 433-0313

NPI assigned

Aug 3, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A 19TH Avenue Dental Care

  • Dentist
  • Phoenix, AZ
  • NPI 1356501662
  NPD (past)

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259798400000",
    "number": "1023249448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E JOAN D ARC AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850224705",
            "telephone_number": "602-367-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 N 19TH AVE",
            "address_2": "SUITE C",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152903",
            "telephone_number": "602-433-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAYDATOV",
        "first_name": "YAKOV",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-03",
        "last_updated": "2009-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "7845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lana Hussein Khatib, PA-C
• Mazen Khattab, MD
• Cameron Reza Khavarimanesh, D.C.
• Khawaja Consulting, P.C.
• Harris Khawaja, D.O.
• Maya Khazei
• Aqeel Khdaier
• Athra Khdaier
• Najah Khdaier
• Kanwal K Kher, MD

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; 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.