Active NPI
Pegah Khazaei, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1205612355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 109216
- Practice address
- 11600 Wilshire Blvd Ste 504
Los Angeles, CA 90025-1788 - Phone
- (310) 231-5100
- NPI assigned
- Sep 5, 2023
- Sex
- Female
- 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 | 109216 | CA | Primary |
Addresses
Primary practice location
11600 Wilshire Blvd Ste 504
Los Angeles, CA 90025-1788
Mailing address
11600 Wilshire Blvd Ste 504
Los Angeles, CA 90025-1788
Phone (310) 231-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109216 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rancho Dentistry | 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 and National Provider Directory roles.
-
- General Practice Dentistry
- Rancho Cucamonga, CA
- NPI 1235023540
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751500800000",
"number": "1205612355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11600 WILSHIRE BLVD STE 504",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251788",
"telephone_number": "310-231-5100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11600 WILSHIRE BLVD STE 504",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251788",
"telephone_number": "310-231-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAZAEI",
"first_name": "PEGAH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-05",
"last_updated": "2025-07-03",
"certification_date": "2025-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "109216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.