Khaled Entabi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

56401 Issued in CA

Practice address

5899 Sunrise Blvd
Citrus Heights, CA 95610-6866

Phone

(916) 967-7766

Fax

(916) 967-7779

NPI assigned

Jan 24, 2008

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 CA

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

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201132800000",
    "number": "1174700827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5899 SUNRISE BLVD",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956106866",
            "telephone_number": "916-967-7766",
            "fax_number": "916-967-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENTABI",
        "first_name": "KHALED",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Taylor Ellison
• Emmanuel Osorio, DDS, Inc.
• Alle Elizabeth Engdahl, BCBA
• Melanie Engelhardt
• Brianna Jo Morgan Engles
• Equanimity Marriage & Counseling Corp
• Kimberly Equihua
• Equinox Health Inc.
• Eric J. Steinbrecher D.D.S., Inc.
• Megan Renee Erickson

• General Practice Dentistry in Citrus Heights, CA
• Providers in Citrus Heights, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; 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.