Individual provider Active NPI

Shachika Khanna, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Philadelphia, PA
National Provider Identifier
1427217694
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
DS039059 Issued in PA
Practice address
909 Walnut Street
300 Cob
Philadelphia, PA 19107-5211
Phone
(215) 955-6215
Fax
(215) 923-9189
NPI assigned
Jun 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS039059 PA
Student in an Organized Health Care Education/Training Program 390200000X
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X DS039059 PA Primary

Addresses

Primary practice location

909 Walnut Street
300 Cob
Philadelphia, PA 19107-5211

Mailing address

909 Walnut Street
300 Cob
Philadelphia, PA 19107-5211
Phone (215) 955-6215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20120716000232 PA Practitioner - Oral Surgery 5193981306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Boston Univ Goldman School of Dental Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1101 Chestnut St
Philadelphia, PA 19107-3619
Phone (800) 533-3669

111 S 11TH St
Philadelphia, PA 19107-4824

3 Crescent Dr
Suite 100
Philadelphia, PA 19112-1016
Phone (215) 955-2392

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-7000

925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS039059PAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Feb 1, 2016 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

950 E Haverford Rd
Ste 307
Bryn Mawr, PA 19010
Phone (610) 519-9125

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

909 Walnut St
#300
Philadelphia, PA 19107
Phone (215) 955-6215

909 Walnut St
Ste 300
Philadelphia, PA 19107
Phone (215) 955-6215

3 Crescent Dr
#4
Philadelphia, PA 19112

1100 Walnut St
Ste 603
Philadelphia, PA 19107
Phone (215) 922-2455

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1427217694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT STREET",
            "address_2": "300 COB",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-6215",
            "fax_number": "215-923-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT STREET",
            "address_2": "300 COB",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-6215",
            "fax_number": "215-923-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANNA",
        "first_name": "SHACHIKA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-03",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS039059",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS039059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.