Kasey Y Farah, DDS
Individual provider
Active NPI
Dentist · Richmond, VA
NPI 1235338708 · NPPES record last updated Aug 4, 2010
Key facts
- NPI
- 1235338708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401411874 (VA)
- Practice address
- 5233 Chamberlayne Avenue
Richmond, VA 23227
- Phone
- (804) 266-5040
- Fax
- (804) 266-5030
- NPI assigned
- Jul 16, 2007
- Sex
- Male
- Sole proprietor
- No
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.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20160112002347 |
VA |
Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery |
5193045136 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 0401411874 | VA | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
0401411874 |
VA |
Yes |
Addresses
Primary practice location
5233 Chamberlayne Avenue
Richmond, VA 23227
Mailing address
201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (719) 562-4447
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 0401411874 | Other | VA | VIRGINIA DEPARTMENT OF HE |