Individual provider Active NPI

Dalia Iftikhar Khan

  • General Practice Dentistry
  • Bayonne, NJ
National Provider Identifier
1669158861
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI03045200 Issued in NJ
Practice address
472 Broadway
Bayonne, NJ 07002-7114
Phone
(551) 232-9748
NPI assigned
Jun 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 22DI03045200 NJ Primary

Addresses

Primary practice location

472 Broadway
Bayonne, NJ 07002-7114

Mailing address

472 Broadway
Bayonne, NJ 07002-7114
Phone (551) 232-9748

Other practice location 1

345 E 24th St
New York, NY 10010-4020
Phone (212) 998-9800

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

LicenseStateTypeSpecialty
22DI03045200NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1669158861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "472 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070027114",
            "telephone_number": "551-232-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "472 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070027114",
            "telephone_number": "551-232-9748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 E 24th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100104020",
            "country_code": "US",
            "telephone_number": "212-998-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "DALIA IFTIKHAR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI03045200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayonne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.