Active NPI
Shuaib M Khaderi, DMD
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1609921980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5455
- Practice address
- 1525 W Thomas Rd
Phoenix, AZ 85015-6102 - Phone
- (602) 263-9039
- Fax
- (602) 263-9071
- NPI assigned
- Jan 24, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5455 | AZ | Primary |
Addresses
Primary practice location
1525 W Thomas Rd
Phoenix, AZ 85015-6102
Mailing address
1525 W Thomas Rd
Phoenix, AZ 85015-6102
Phone (602) 263-9039
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 |
|---|---|---|---|
| 5455 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Niknav PLLC | General Practice | Past | Accepting new patients |
| Nobuaki Management | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609921980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 W THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850156102",
"telephone_number": "602-263-9039",
"fax_number": "602-263-9071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 W THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850156102",
"telephone_number": "602-263-9039",
"fax_number": "602-263-9071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHADERI",
"first_name": "SHUAIB",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "5455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.