Omar Kholaki, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

102062 Issued in CA

Practice address

2080 Century Park E Ste 610
Los Angeles, CA 90067-2009

Phone

(424) 209-4190

NPI assigned

May 21, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 17, 2024 through Jul 17, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: okholaki67056@direct.phhs.org

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

{
    "created_epoch": "1463788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656115200000",
    "number": "1750738555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3863 SKY VIEW LN",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912141006",
            "telephone_number": "818-469-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E STE 610",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672009",
            "telephone_number": "424-209-4190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3863 Sky View Ln",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912141006",
            "country_code": "US",
            "telephone_number": "818-469-9502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOLAKI",
        "first_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-21",
        "last_updated": "2022-06-25",
        "certification_date": "2022-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "102062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omid Khodadadi, M.D.
• Farzaneh N/a Khodaparast
• Hannah M Khoddam, PHD
• Rubin Khoddam, M.A.
• Scarlet Khodi
• Zaina Kholaki
• Erica Kholodovsky, LCSW
• Rattikal Khongmun
• Apichai Khongphatthanayothin, M.D.
• Catherine Peony Khoo, MD

• Oral and Maxillofacial Surgery (Dentist) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.