Kamran Nawaz Raja, DMD, MD, FACS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401416412 Issued in VA

Practice address

24805 Pinebrook Rd Ste 318
Chantilly, VA 20152

Phone

(703) 653-0989

Fax

(703) 653-0989

NPI assigned

Feb 15, 2007

Last updated

Nov 12, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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 Nov 15, 2013 through Nov 15, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Riding Oral and Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Chantilly, VA
  • NPI 1285296814
  NPD (past) Authorized official
• Southern Maryland Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Waldorf, MD
  • NPI 1174559298
  NPD (past)

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1528101805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9209 MAROVELLI FOREST DR",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220793456",
            "telephone_number": "571-218-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24805 PINEBROOK RD STE 318",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "20152",
            "telephone_number": "703-653-0989",
            "fax_number": "703-653-0989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10406 Courthouse Rd",
            "address_purpose": "LOCATION",
            "city": "Spotsylvania",
            "state": "VA",
            "postal_code": "225531712",
            "country_code": "US",
            "telephone_number": "540-898-7645",
            "fax_number": "540-898-7043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAJA",
        "first_name": "KAMRAN",
        "middle_name": "NAWAZ",
        "name_prefix": "Dr.",
        "credential": "DMD, MD, FACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "13740",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401416412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.southridingos.com",
            "affiliation": "N",
            "address_1": "24805 Pinebrook Rd Ste 318",
            "city": "Chantilly",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201524126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Quest Diagnostics Nichols Institute, Inc.
• Margaret Quezada, BSN, RN, IBCLC
• Sean M Quinn, PA
• Katherine Radd, PT, DPT
• Masiha Rafiqzad
• Mallory Rakow
• Ashley Ralston
• Shakir Ramadhan
• Mohammad M Rana, M.D.
• Kelly Rankin, LCSW

• Oral and Maxillofacial Surgery (Dentist) in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.