Dmitry Khodik, M.ED.

Primary specialty

SpecialistTaxonomy code 174400000X

License

CERT.# Issued in NY

Practice address

22215 Kingsbury Ave
Oakland Gardens, NY 11364-3649

Phone

(718) 776-8358

NPI assigned

Jun 11, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

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.

• Tatyana and Dmitry Khodik, LLC

  • Early Intervention Provider Agency
  • Oakland Gardens, NY
  • NPI 1114391836
  NPD (past) Authorized official

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689936262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22215 KINGSBURY AVE",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113643649",
            "telephone_number": "718-776-8358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22215 KINGSBURY AVE",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113643649",
            "telephone_number": "718-776-8358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHODIK",
        "first_name": "DMITRY",
        "name_prefix": "Mr.",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "CERT.#",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Kavadlo-Cohen, MSPED
• Kenetic Physical Therapy PC
• Paige Kenis
• Kenneth R. Siva, D.D.S., P.C.
• Annie Keung, D.M.D.
• Tatyana Khodik, M.S., OTR/L
• Chang Jong Kim
• Grace Eunhae Kim
• Hojung Kim, RPH
• Ji Young Kim

• All providers in Oakland Gardens, NY
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.