Individual provider Active NPI

Liliana Gaby Khabbaz, DDS

  • General Practice Dentistry
  • Pasadena, CA
National Provider Identifier
1437245305
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
43987 Issued in CA
Practice address
310 S Lake Ave
Pasadena, CA 91101-3537
Phone
(626) 795-6855
Fax
(626) 432-4270
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 43987 CA
General Practice Dentistry 1223G0001X 43987 CA Primary

Addresses

Primary practice location

310 S Lake Ave
Pasadena, CA 91101-3537

Mailing address

310 S Lake Ave
Pasadena, CA 91101-3537
Phone (626) 795-6855

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: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170515000907 CA Practitioner - Oral Surgery 4587941802

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
43987CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Leon D. Roisman, D.M.D., Inc. General Practice PastSince Apr 1, 2017 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1437245305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S LAKE AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911013537",
            "telephone_number": "626-795-6855",
            "fax_number": "626-432-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S LAKE AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911013537",
            "telephone_number": "626-795-6855",
            "fax_number": "626-432-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHABBAZ",
        "first_name": "LILIANA",
        "middle_name": "GABY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "43987",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.