Active NPI
Kourosh Keikhanzadeh, D.D.S., M.D.SC
- Endodontics
- Encino, CA
National Provider Identifier
1417154642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 53806
- Practice address
- 16661 Ventura Blvd
Suite #609
Encino, CA 91436-1914 - Phone
- (818) 344-3559
- NPI assigned
- Jun 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 53806 | CA | Primary |
Addresses
Primary practice location
16661 Ventura Blvd
Suite #609
Encino, CA 91436-1914
Mailing address
16661 Ventura Blvd
Suite #609
Encino, CA 91436-1914
Phone (818) 344-3559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170502001474 | CA | Order and Referring Only - Other (Non-Physician) | 5496075574 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53806 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445472000000",
"number": "1417154642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16661 VENTURA BLVD",
"address_2": "SUITE #609",
"city": "ENCINO",
"state": "CA",
"postal_code": "914361914",
"telephone_number": "818-344-3559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16661 VENTURA BLVD",
"address_2": "SUITE #609",
"city": "ENCINO",
"state": "CA",
"postal_code": "914361914",
"telephone_number": "818-344-3559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEIKHANZADEH",
"first_name": "KOUROSH",
"name_prefix": "Dr.",
"credential": "D.D.S., M.D.SC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2015-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "53806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; 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.