Alireza Khansari, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

49590 Issued in CA

Practice address

12630 Monte Vista Road. #204
Poway, CA 92064

Phone

(858) 679-0142

Fax

(858) 679-0165

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Eskeland and Ettefagh Dental Corporation

  • General Practice Dentistry
  • La Jolla, CA
  • NPI 1134214281
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1821183864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA ROAD. #204",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "92064",
            "telephone_number": "858-679-0142",
            "fax_number": "858-679-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA ROAD. #204",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "92064",
            "telephone_number": "858-679-0142",
            "fax_number": "858-679-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANSARI",
        "first_name": "ALIREZA",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "49590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Satya Kethineni
• Suzanne Denise Ketring
• Kevin Lloyd Kohler DMD Inc
• Kevin Schwartz M D a Medical Corporation
• Shafi M. Khalid, M.D.
• Sonal Khattri, MD
• Kiyana Kianfar-Jagoda, LMFT, PSY.D
• Kidisthenics Fitness Company
• Jayma E Kim, M.F.T.
• Perla Figa Kimball, L.AC

• Periodontics in Poway, CA
• Providers in Poway, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.