Hossein A Jalali, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

10256 Issued in MN

Practice address

991 9TH Ave NW
New Brighton, MN 55112-2665

Phone

(651) 633-1311

Fax

(651) 633-4339

NPI assigned

Dec 9, 2005

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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.

• Long Lake Family Denistry

  • General Practice Dentistry
  • New Brighton, MN
  • NPI 1134574163
  NPD (past) Authorized official

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1417932773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 9TH AVE NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122665",
            "telephone_number": "651-633-1311",
            "fax_number": "651-633-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 9TH AVE NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122665",
            "telephone_number": "651-633-1311",
            "fax_number": "651-633-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALALI",
        "first_name": "HOSSEIN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "10256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "0009762",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Ites, LPCC, LADC
• Susan Ivancie
• Andrea Lauren Iyegha, MA, LICSW
• Jacob Services LLC
• Elizabeth Jacobson
• Amina Ismail Jama
• Kay Irene James, OTR/L, CLT
• Jeffrey S. Berryhill, PH.D, PLLC
• Jennifer Lindh, PH.D., LP LLC
• Alison Elizabeth Johnson

• Dentist in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; 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.