Active NPI
Jacob Khan, DMD
- Dentist
- San Diego, CA
National Provider Identifier
1730758152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12355693-9921
- Practice address
- 34800 Bob Wilson Dr Ste 1
San Diego, CA 92134-1001 - Phone
- (619) 532-8600
- NPI assigned
- Jun 21, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12355693-9921 | UT | Primary |
Addresses
Primary practice location
34800 Bob Wilson Dr Ste 1
San Diego, CA 92134-1001
Mailing address
34800 Bob Wilson Dr
San Diego, CA 92134-1098
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 |
|---|---|---|---|
| 12355693-9921 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1730758152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921341098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR STE 1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921341001",
"telephone_number": "619-532-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-21",
"last_updated": "2021-08-31",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "12355693-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.