Active NPI
Azam Zari Khaledi, D.M.D
- Pediatric Dentistry
- Great Neck, NY
National Provider Identifier
1609020882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 048026-1
- Practice address
- 17 Maple Dr Ste 6
Great Neck, NY 11021-2000 - Phone
- (646) 483-8708
- NPI assigned
- Nov 14, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 048026-1 | NY | Primary |
Addresses
Primary practice location
17 Maple Dr Ste 6
Great Neck, NY 11021-2000
Mailing address
17 Maple Dr Ste 6
Great Neck, NY 11021-2000
Phone (646) 483-8708
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 |
|---|---|---|---|
| 048026-1 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553817600000",
"number": "1609020882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 MAPLE DR STE 6",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212000",
"telephone_number": "646-483-8708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 MAPLE DR STE 6",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212000",
"telephone_number": "646-483-8708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHALEDI",
"first_name": "AZAM",
"middle_name": "ZARI",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-14",
"last_updated": "2019-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "048026-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.