Active NPI
Roham Kashanimoghaddam
- Dentist
- Chicago, IL
National Provider Identifier
1841078193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.034372
- Practice address
- 6258 S Pulaski Rd
Chicago, IL 60629-4610 - Phone
- (773) 777-6363
- NPI assigned
- Sep 18, 2023
- Last updated
- Sep 18, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.034372 | IL | Primary |
Addresses
Primary practice location
6258 S Pulaski Rd
Chicago, IL 60629-4610
Mailing address
512 N McClurg CT Apt 3011
Chicago, IL 60611-4120
Phone (773) 603-6232
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.034372 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pulaski Road Dentistry PLLC | Dentist | Current | Accepting new patients |
| Midway Family Dental, LLC | Dentist | Past | Accepting new patients |
Locations
6258 S Pulaski Rd
Chicago, IL 60629
Phone (773) 777-6363
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1841078193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 N MCCLURG CT APT 3011",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114120",
"telephone_number": "773-603-6232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6258 S PULASKI RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606294610",
"telephone_number": "773-777-6363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASHANIMOGHADDAM",
"first_name": "ROHAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-18",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.034372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.