Individual provider Active NPI

Nasrin Khorram, DDS

  • General Practice Dentistry
  • Hawthorne, CA
National Provider Identifier
1538212790
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
45475 Issued in CA
Practice address
13450 Hawthorne Blvd
Hawthorne, CA 90250-5806
Phone
(310) 679-0106
Fax
(310) 679-6698
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 45475 CA Primary

Addresses

Primary practice location

13450 Hawthorne Blvd
Hawthorne, CA 90250-5806

Mailing address

13450 Hawthorne Blvd
Hawthorne, CA 90250-5806
Phone (310) 679-0106

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151113000806 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9436469848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
45475CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Nasrin Khorram Dental Corp. Current Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538212790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13450 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505806",
            "telephone_number": "310-679-0106",
            "fax_number": "310-679-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13450 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505806",
            "telephone_number": "310-679-0106",
            "fax_number": "310-679-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHORRAM",
        "first_name": "NASRIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.