Individual provider Active NPI

John M Nakhla, DDS

  • General Practice Dentistry
  • San Ramon, CA
National Provider Identifier
1184912693
Registry record updated Jul 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
60501 Issued in CA
Practice address
2821 Crow Canyon Rd
Suite 200
San Ramon, CA 94583-1659
Phone
(925) 837-8765
Fax
(925) 837-1660
NPI assigned
Jul 18, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 60501 CA Primary

Addresses

Primary practice location

2821 Crow Canyon Rd
Suite 200
San Ramon, CA 94583-1659

Mailing address

2821 Crow Canyon Rd
Suite 200
San Ramon, CA 94583-1659
Phone (925) 837-8765

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150806010941 CA Order and Referring Only - DentistPractitioner - Dentist 5092029827

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60501CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Nakhla Dental Group PastSince Oct 25, 2020 Accepting new patients
San Ramon Dental Arts Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1184912693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 CROW CANYON RD",
            "address_2": "SUITE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831659",
            "telephone_number": "925-837-8765",
            "fax_number": "925-837-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 CROW CANYON RD",
            "address_2": "SUITE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831659",
            "telephone_number": "925-837-8765",
            "fax_number": "925-837-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKHLA",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-18",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "60501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ramon, CA

Sources for this page

Verify at the official NPI Registry.