NPIMap

Organization Active NPI

Katsura Khalil Nakazato Khosrovani DDS Inc.

  • Pediatric Dentistry
  • Berkeley, CA
National Provider Identifier
1043340227
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
32728 Issued in CA
Legal business name
KATSURA KHALIL NAKAZATO KHOSROVANI DDS INC.
Practice address
2640 Telegraph Ave
Suite 101
Berkeley, CA 94704-3374
Phone
(510) 848-6494
Fax
(510) 981-1159
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Authorized official

Name
Mahi Amerino
Title
Dental Practice Administrator
Phone
(510) 848-6494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 32728 CA Primary

Addresses

Primary practice location

2640 Telegraph Ave
Suite 101
Berkeley, CA 94704-3374

Mailing address

2640 Telegraph Ave
Suite 101
Berkeley, CA 94704-3374
Phone (510) 848-6494

Other names 2

  • Aloha Pediatric Dentistry Doing business as
  • Pediatric Dentistry Other name

National Provider Directory

National Provider Directory

Locations

3010 Colby St
Ste 217
Berkeley, CA 94705
Phone (510) 848-6494

2640 Telegraph Ave
Ste 101
Berkeley, CA 94704
Phone (510) 848-6494

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1043340227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 TELEGRAPH AVE",
            "address_2": "SUITE 101",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043374",
            "telephone_number": "510-848-6494",
            "fax_number": "510-981-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 TELEGRAPH AVE",
            "address_2": "SUITE 101",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043374",
            "telephone_number": "510-848-6494",
            "fax_number": "510-981-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATSURA KHALIL NAKAZATO KHOSROVANI DDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "AMERINO",
        "authorized_official_first_name": "MAHI",
        "authorized_official_title_or_position": "DENTAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "510-848-6494"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "32728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aloha Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; 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.