Active NPI
Keyoumars Izadi, MD, DDS
- Dentist
- Fredericksburg, VA
National Provider Identifier
1184732216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401412094
- Practice address
- 409 Chatham Square Office Park
Fredericksburg, VA 22405-2561 - Phone
- (540) 371-4131
- Fax
- (540) 371-5621
- NPI assigned
- Aug 28, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 0101243951 | VA | |
| Dentist | 122300000X | 0401412094 | VA | Primary |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 0438000243 | VA |
Addresses
Primary practice location
409 Chatham Square Office Park
Fredericksburg, VA 22405-2561
Mailing address
409 Chatham Square Office Park
Fredericksburg, VA 22405-2561
Phone (540) 371-4131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 7, 2012 through Dec 7, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401412094 | VA | MD | Dentist |
| 0438000243 | VA | MD | Oral and Maxillofacial Surgery (Dentist) |
| 0101243951 | VA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1184732216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 CHATHAM SQUARE OFFICE PARK",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224052561",
"telephone_number": "540-371-4131",
"fax_number": "540-371-5621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 CHATHAM SQUARE OFFICE PARK",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224052561",
"telephone_number": "540-371-4131",
"fax_number": "540-371-5621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZADI",
"first_name": "KEYOUMARS",
"name_prefix": "Dr.",
"credential": "MD, DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "VA",
"license": "0101243951",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401412094",
"primary": true
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "VA",
"license": "0438000243",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.