Individual provider Active NPI

Jason Nikkhah, D.M.D.

  • Dentist
  • Leesburg, VA
National Provider Identifier
1174928816
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401414653 Issued in VA
Practice address
163 Fort Evans Rd NE
Leesburg, VA 20176-4420
Phone
(703) 459-5231
NPI assigned
Oct 23, 2014
Last updated
Oct 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211214002741 VA Order and Referring Only - DentistPractitioner - Dentist 0749670321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401414653VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew 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

Verify at the official NPI Registry.