Active NPI
Khaled Sudki Fawaz, DDS
- Dentist
- Mission Viejo, CA
National Provider Identifier
1518214113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 40586
- Practice address
- 26902 Oso Pkwy
Suite 190
Mission Viejo, CA 92691-5801 - Phone
- (949) 582-9206
- NPI assigned
- Aug 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40586 | CA | Primary |
Addresses
Primary practice location
26902 Oso Pkwy
Suite 190
Mission Viejo, CA 92691-5801
Mailing address
26902 Oso Pkwy Ste 190
Mission Viejo, CA 92691-5808
Phone (949) 582-9206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40586 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1518214113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26902 OSO PKWY STE 190",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926915808",
"telephone_number": "949-582-9206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26902 OSO PKWY",
"address_2": "SUITE 190",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926915801",
"telephone_number": "949-582-9206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWAZ",
"first_name": "KHALED",
"middle_name": "SUDKI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-14",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "40586",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.