Individual provider Active NPI

David Khakshoor

  • Primary Podiatric Medicine Podiatrist
  • Los Angeles, CA
National Provider Identifier
1811476658
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
E5807 Issued in CA
Practice address
2080 Century Park E Ste 1207
Los Angeles, CA 90067-2015
Phone
(410) 725-3363
NPI assigned
Aug 13, 2018
Last updated
Oct 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E5807 CA
Primary Podiatric Medicine Podiatrist 213EP1101X E5807 CA Primary
Foot & Ankle Surgery Podiatrist 213ES0103X E5807 CA

Addresses

Primary practice location

2080 Century Park E Ste 1207
Los Angeles, CA 90067-2015

Mailing address

1220 Manning Ave Apt 14
Los Angeles, CA 90024-5078
Phone (410) 725-3363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20211203002565 CA Practitioner - Podiatry 7618367913 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2080 Century Park E
Suite 1207
Los Angeles, CA 90067-2015
Phone (410) 725-3363

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue218
Removal of nail tissue2603
Removal or shaving of skin growth1402
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E5807CAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael D. Kotzen, Inc. Foot & Ankle Surgery CurrentSince May 10, 2022 Accepting new patients
Home Foot Care, Inc. Podiatrist CurrentSince May 10, 2022 Accepting new patients
Optimal Foot and Ankle Institute CurrentSince Oct 7, 2021 Accepting new patients

Locations

2080 Century Park E
Ste 1207
Los Angeles, CA 90067
Phone (310) 553-2122

12520 Magnolia Blvd
Ste 304
Valley Vlg, CA 91607
Phone (818) 452-9902

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1811476658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MANNING AVE APT 14",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245078",
            "telephone_number": "410-725-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E STE 1207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672015",
            "telephone_number": "410-725-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAKSHOOR",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-13",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E5807",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E5807",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5807",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.