Jay Khorsandi, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

49561 Issued in CA

Practice address

5400 Balboa Blvd Ste 120
Encino, CA 91316-5200

Phone

(818) 205-1122

Fax

(818) 386-8963

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 11, 2019 through Jan 11, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1205855293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 120",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165200",
            "telephone_number": "818-205-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 120",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165200",
            "telephone_number": "818-205-1122",
            "fax_number": "818-386-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHORSANDI",
        "first_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "056821",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaghayegh Khodadadzadeh
• Khodamrad Payman, M.D., Inc.
• Kathy Khoie, PH.D.
• Ronit Khoobbayan, PA-C
• Shabnam Khorsand
• Nazly Khorsandi, DDS.
• Sam S Khorsandi, D.D.S
• Shira Khoshkerman, PA-C
• Khosro Sadeghani MD. Inc
• Arpin V. Khostegyan, DDS

• General Practice Dentistry in Encino, CA
• Providers in Encino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.

Verify at the official NPI Registry.