Avasa Nalini Jagan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

060613 Issued in NY

Practice address

11512 Liberty Ave Ste 2B
Jamaica, NY 11419-1902

Phone

(929) 499-3287

NPI assigned

Jan 11, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Avasa Nalini Jagan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1023582152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 STILLWELL AVE APT 3B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112242685",
            "telephone_number": "347-320-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LIBERTY AVE STE 2B",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114191902",
            "telephone_number": "929-499-3287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1545 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112131122",
            "country_code": "US",
            "telephone_number": "718-613-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAGAN",
        "first_name": "AVASA",
        "middle_name": "NALINI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "060613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AVASA",
            "last_name": "JAGAN",
            "middle_name": "NALINI",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Dentist in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.