Mohamed Ihsan Kayali, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

44495 Issued in CA

Practice address

1111 W Covina Blvd
Suite 220
San Dimas, CA 91773-3205

Phone

(909) 599-9510

Fax

(909) 599-1610

NPI assigned

Dec 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes
• 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.

• San Dimas Periodontics

  • Periodontics
  • San Dimas, CA
  • NPI 1033261391
  NPD (past) Authorized official

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477612406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W COVINA BLVD",
            "address_2": "SUITE 220",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733205",
            "telephone_number": "909-599-9510",
            "fax_number": "909-599-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W COVINA BLVD",
            "address_2": "SUITE 220",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733205",
            "telephone_number": "909-599-9510",
            "fax_number": "909-599-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAYALI",
        "first_name": "MOHAMED",
        "middle_name": "IHSAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "44495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ziad Kassab, D.D.S
• Christopher E Kassar, DO
• Morgan Kassner
• Kathryn a. Perry, D.O., Inc.
• Kavitha Kotrappa M D Inc
• Mohammed Walid Khalife, M.D.
• Jessica Kiesendahl, MFT
• Abraham Kim, OT
• Brina Kim
• Crystal Kim, RPH

• Periodontics in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.