Individual provider Active NPI

Irene Kakosyan, D.D.S.

  • General Practice Dentistry
  • New York, NY
National Provider Identifier
1215135074
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
049136-1 Issued in NY
Practice address
405 Lexington Ave
Floor 21
New York, NY 10174-0002
Phone
(212) 661-9777
Fax
(212) 661-9779
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 049136-1 NY Primary

Addresses

Primary practice location

405 Lexington Ave
Floor 21
New York, NY 10174-0002

Mailing address

163 Ridgewood Ave
Glen Ridge, NJ 07028-1104
Phone (212) 661-9777

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

LicenseStateTypeSpecialty
049136-1NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Om Dental Arts, PLLC PastSince Nov 10, 2019 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.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215135074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 RIDGEWOOD AVE",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281104",
            "telephone_number": "212-661-9777",
            "fax_number": "212-661-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 LEXINGTON AVE",
            "address_2": "FLOOR 21",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101740002",
            "telephone_number": "212-661-9777",
            "fax_number": "212-661-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKOSYAN",
        "first_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049136-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.