Sumra Shahin Khan, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

1855555 Issued in MA

Practice address

39 Cross St
Suite 307
Peabody, MA 01960-1670

Phone

(978) 717-5819

Fax

(978) 717-5826

NPI assigned

Apr 1, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 16, 2016 through Mar 16, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1487826145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 CROSS ST",
            "address_2": "SUITE 307",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601670",
            "telephone_number": "978-717-5819",
            "fax_number": "978-717-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 CROSS ST",
            "address_2": "SUITE 307",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601670",
            "telephone_number": "978-717-5819",
            "fax_number": "978-717-5826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SUMRA",
        "middle_name": "SHAHIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-01",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "19089",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "1855555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Michael Kelley, PA-C
• Natalie A Kendall, PA-C
• Kenneth H Titel DMD PC
• Christen Jean Kenrick, O.D.
• Ann Kent-Gasiorowski, O.D.
• Maha Mi Khodeir, MD
• Sevda Sahra Kilic
• Connie Tran Kim, MD
• Dongho Kim
• Jemin Kim, DMD

• Dentist in Peabody, MA
• Providers in Peabody, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.