Active NPI
Shivam Malhan
- Dentist
- Peoria, IL
National Provider Identifier
1801626668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.037279
- Practice address
- 7417 N Knoxville Ave
Peoria, IL 61614-2019 - Phone
- (309) 322-1220
- NPI assigned
- Aug 6, 2024
- Reactivated
- Aug 19, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.037279 | IL | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
7417 N Knoxville Ave
Peoria, IL 61614-2019
Mailing address
7417 Knoxville Avenue
Peoria, IL 61614
Phone (309) 322-1220
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788825600000",
"number": "1801626668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7417 KNOXVILLE AVENUE",
"city": "PEORIA",
"state": "IL",
"postal_code": "61614",
"telephone_number": "309-322-1220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7417 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616142019",
"telephone_number": "309-322-1220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALHAN",
"first_name": "SHIVAM",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-06",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"deactivation_date": "2025-05-13",
"reactivation_date": "2026-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.037279",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.