NPIMap

Organization Active NPI

Luxe Dental PC

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1508535659
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LUXE DENTAL PC
Practice address
1411 Coney Island Ave
Brooklyn, NY 11230-4137
Phone
(718) 484-1560
NPI assigned
Sep 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Authorized official

Name
Dr. Kimia Kohanbash, DDSNPI 1326509316
Title
Owner
Phone
(718) 484-1560

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1411 Coney Island Ave
Brooklyn, NY 11230-4137

Mailing address

1411 Coney Island Ave
Brooklyn, NY 11230-4137
Phone (718) 484-1560

Other identifiers 1

IdentifierTypeStateIssuer
06283352MedicaidNY

Other names 1

  • NY Dental Boutique Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1508535659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112304137",
            "telephone_number": "718-484-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112304137",
            "telephone_number": "718-484-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUXE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-12",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "KOHANBASH",
        "authorized_official_first_name": "KIMIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-484-1560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06283352",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NY Dental Boutique",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NY Dental Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.