Gaith Khatlan, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.031631 Issued in IL

Practice address

2241 Theodore St
Crest Hill, IL 60403-1881

Phone

(815) 741-1700

NPI assigned

Jun 7, 2018

Last updated

May 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ghaith Al Khuzaie Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1326531088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 WASHINGTON BLVD APT 3I",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603023660",
            "telephone_number": "206-375-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 THEODORE ST",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031881",
            "telephone_number": "815-741-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7710 W North Ave",
            "address_purpose": "LOCATION",
            "city": "Elmwood Park",
            "state": "IL",
            "postal_code": "607074123",
            "country_code": "US",
            "telephone_number": "206-375-7915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHATLAN",
        "first_name": "GAITH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-07",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.031631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GHAITH",
            "last_name": "AL KHUZAIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rolla Naim Kattoum, DMD
• Stephanie Kazantsev, M.D.
• Carly Kelleher, PA-C
• Matthew R Kelleher, MD
• Samia Khan, D.D.S.
• Hilwa Khattab
• Richard Kiang, M.D.
• Dee Dee Kimbrough, COTA/L
• Amy Kozak, PT
• John Stephan Kravarik, D.C.

• Dentist in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.