Individual provider Active NPI

Saif Kargoli, DDS

  • Endodontics
  • Chantilly, VA
National Provider Identifier
1396153375
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
0401415175 Issued in VA
Practice address
14337 Newbrook Dr Ste 200
Chantilly, VA 20151-4259
Phone
(703) 214-2113
NPI assigned
Jul 23, 2014
Last updated
Apr 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 0401415175 VA Primary
Student in an Organized Health Care Education/Training Program 390200000X 1340 FL
Student in an Organized Health Care Education/Training Program 390200000X NY

Addresses

Primary practice location

14337 Newbrook Dr Ste 200
Chantilly, VA 20151-4259

Mailing address

100 Haven Ave
New York, NY 10032-2645
Phone (703) 214-2113

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
0401415175VAMDEndodontist
1340FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Endodontics PLLC Endodontics Current Accepting new patients
Chantilly Modern Dentistry, PC PastSince Apr 26, 2020 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1396153375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HAVEN AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100322645",
            "telephone_number": "703-214-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14337 NEWBROOK DR STE 200",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201514259",
            "telephone_number": "703-214-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARGOLI",
        "first_name": "SAIF",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-23",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401415175",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "1340",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; 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.