Hamid Cohen Kheradyar, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39023 Issued in CA

Practice address

138 S Gaffey St
San Pedro, CA 90731-2430

Phone

(310) 514-9100

NPI assigned

Nov 30, 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

Other identifiers 2

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

Locations

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.

• Hamid Cohen Kheradyar, DDS, Inc.

  • Dental Clinic/Center
  • San Pedro, CA
  • NPI 1891993036
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851469985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 S GAFFEY ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312430",
            "telephone_number": "310-514-9100",
            "fax_number": "310-514-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 S GAFFEY ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312430",
            "telephone_number": "310-514-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHERADYAR",
        "first_name": "HAMID",
        "middle_name": "COHEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL TREATING PROVID",
            "identifier": "D39023",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL BILLING PROVIDE",
            "identifier": "G-898601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reina Kawazoe
• Paul E Kender, PT
• Keo Care
• Matthew R Keough
• Michael Kerckhoff
• Belinda Kim Khou
• Basimah Khulusi, MD
• Kidspeak Pediatric Speech and Language Services, Inc.
• Cailine Y Kim
• Grace Kim

• General Practice Dentistry in San Pedro, CA
• Providers in San Pedro, CA by specialty
• General Practice Dentistry 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.