Individual provider Active NPI

Aysha Karim Momin, D.D.S.

  • Dentist
  • Boca Raton, FL
National Provider Identifier
1649319690
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN17819 Issued in FL
Practice address
9767 Palma Vista Way
Boca Raton, FL 33428-3528
Phone
(561) 859-6301
Fax
(561) 487-7956
NPI assigned
Feb 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN17819 FL Primary

Addresses

Primary practice location

9767 Palma Vista Way
Boca Raton, FL 33428-3528

Mailing address

9767 Palma Vista Way
Boca Raton, FL 33428-3528
Phone (561) 859-6301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20170106001441 FL Order and Referring Only - DentistPractitioner - Other (Physician)Practitioner - Dentist 8527349455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1649319690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9767 PALMA VISTA WAY",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334283528",
            "telephone_number": "561-859-6301",
            "fax_number": "561-487-7956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9767 PALMA VISTA WAY",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334283528",
            "telephone_number": "561-859-6301",
            "fax_number": "561-487-7956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMIN",
        "first_name": "AYSHA",
        "middle_name": "KARIM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN17819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.