Individual provider Active NPI

Mojgan Danyal Khosravi, DMD

  • General Practice Dentistry
  • Houston, TX
National Provider Identifier
1790674661
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41759 Issued in TX
Practice address
6601 S Braeswood Blvd
Houston, TX 77096-3687
Phone
(832) 930-7803
NPI assigned
Jul 2, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 41759 TX Primary

Addresses

Primary practice location

6601 S Braeswood Blvd
Houston, TX 77096-3687

Mailing address

5214 Eagle Pointe CT
Sugar Land, TX 77479-4216
Phone (920) 815-9022

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
41759TXMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1790674661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5214 EAGLE POINTE CT",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774794216",
            "telephone_number": "920-815-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 S BRAESWOOD BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770963687",
            "telephone_number": "832-930-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANYAL KHOSRAVI",
        "first_name": "MOJGAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "41759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; 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.