Jack Issac Krajekian, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

116 Issued in WV

Practice address

1215 Virginia St E
Charleston, WV 25301-2908

Phone

(304) 345-1092

Fax

(304) 345-1095

NPI assigned

Nov 25, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790768562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 VIRGINIA ST E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253012908",
            "telephone_number": "304-345-1092",
            "fax_number": "304-345-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 VIRGINIA ST E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253012908",
            "telephone_number": "304-345-1092",
            "fax_number": "304-345-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAJEKIAN",
        "first_name": "JACK",
        "middle_name": "ISSAC",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "3542",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "116",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS036241",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "19714",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002152000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather R Kosarek, M.S. CCC-SLP
• Augusta Blundon Kosowicz, PA-C
• Denise Ohlsen Koster
• Fenilkumar Shambhubhai Kotadiya, MD
• Jeremy Travis Kozen, PTA
• Devin Kramer
• Evgenii Kravchenko, M.D.
• Robert M Krieg, DDS
• Aaliyah Krismer
• Kroger Limited Partnership I

• Oral and Maxillofacial Surgery (Dentist) in Charleston, WV
• Providers in Charleston, WV by specialty
• Oral and Maxillofacial Surgery (Dentist) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.