Mohamed Elkhazin, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

104641 Issued in CA

Practice address

11348 N Blue Sage Ave
Fresno, CA 93730-8846

Phone

(424) 324-4102

NPI assigned

Jun 17, 2019

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

• Mohamed Elkhazin Other name

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• United Health Centers of the San Joaquin Valley

  • Federally Qualified Health Center (FQHC)
  • Huron, CA
  • NPI 1134101686
  NPD (past)
• Edp of Illinois P.C

  dba Affordable Dental of Illnois

  • Dental Clinic/Center
  • Dupo, IL
  • NPI 1154712784
  NPD (past)
• Michael J Bentley DDS LTD

  • General Practice Dentistry
  • Creve Coeur, IL
  • NPI 1568539096
  NPD (past)

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1366002933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11348 N BLUE SAGE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937308846",
            "telephone_number": "424-324-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11348 N BLUE SAGE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937308846",
            "telephone_number": "424-324-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKHAZIN",
        "first_name": "MOHAMED",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "104641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOHAMED",
            "last_name": "ELKHAZIN",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ariana Guadalupe Elizalde
• Brianne Alexis Elizalde
• Raul Lino Elizalde Jr.
• Vanity Elizondo
• Joanna Elkassis, PHARM D
• Aaron Micheal Elkin
• Andrew Elkins, DDS
• Obadiah Elkins, MD
• Jeremiah Seron Ellard
• Laquista T Ellard

• Dentist in Fresno, CA
• Providers in Fresno, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.