Isam Hanna Khoury, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DP035922 Issued in CA

Practice address

1500 Southgate Ave
#103
Daly City, CA 94015-2259

Phone

(650) 991-0999

Fax

(650) 991-0918

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 9, 2018 through Mar 9, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801952239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SOUTHGATE AVE",
            "address_2": "#103",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152259",
            "telephone_number": "650-991-0999",
            "fax_number": "650-991-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SOUTHGATE AVE",
            "address_2": "#103",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152259",
            "telephone_number": "650-991-0999",
            "fax_number": "650-991-0918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOURY",
        "first_name": "ISAM",
        "middle_name": "HANNA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DP035922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B35922-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aman Shabi Khan, MD
• Rehan Khan, PAC
• Shaista Khanoon
• Ye Khant
• Nirmal Kharel, MD
• Mona Khoury
• Vivian Sami Khoury, DMD
• Anadelia B Kim, NP
• Esther Jin Kim, M.D.
• Han Seong Kim, D.C.

• Oral and Maxillofacial Surgery (Dentist) in Daly City, CA
• Providers in Daly City, 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 Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.