Active NPI
Jason Nikkhah, D.M.D.
- Dentist
- Leesburg, VA
National Provider Identifier
1174928816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401414653
- Practice address
- 163 Fort Evans Rd NE
Leesburg, VA 20176-4420 - Phone
- (703) 459-5231
- NPI assigned
- Oct 23, 2014
- Last updated
- Oct 11, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401414653 | VA | Primary |
Addresses
Primary practice location
163 Fort Evans Rd NE
Leesburg, VA 20176-4420
Mailing address
847 Ferndale Ter NE
Leesburg, VA 20176-4872
Phone (703) 459-5231
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211214002741 | VA | Order and Referring Only - Dentist | 0749670321 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414653 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Naderplc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633910400000",
"number": "1174928816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 FERNDALE TER NE",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201764872",
"telephone_number": "703-459-5231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 FORT EVANS RD NE",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201764420",
"telephone_number": "703-459-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKKHAH",
"first_name": "JASON",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-23",
"last_updated": "2021-10-11",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401414653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.