Pedram Khosravian, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

25904 Issued in TX

Practice address

1920 Corporate Dr. Ste 107a
San Marcos, TX 78666

Phone

(512) 722-6338

NPI assigned

Aug 31, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1770716243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 CORPORATE DR. STE 107A",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "78666",
            "telephone_number": "512-722-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 CORPORATE DR. STE 107A",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "78666",
            "telephone_number": "512-722-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOSRAVIAN",
        "first_name": "PEDRAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-31",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58700",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "25904",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25904",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Addison Rose Key
• Hisham Khan
• Jamshaid Aslam Khan, DDS
• Fong Yong Jane Khor, MPT
• Niloofar Khosravian
• Pejman Khosravian, D.M.D
• Ki Charter Academy
• Jadyn Killian, SLPA
• Dawn Nicole Kim-Romo, PHARM.D.
• Anne-Marie Kimbell, PHD

• Endodontics in San Marcos, TX
• Providers in San Marcos, TX by specialty
• Endodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.