Naz Khatiblou, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105346 Issued in CA

Practice address

31726 Rancho Viejo Rd Ste 103
San Juan Capistrano, CA 92675-2723

Phone

(949) 493-7007

NPI assigned

Oct 10, 2020

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1602288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602288000000",
    "number": "1851999007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 DAYTONA DR",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775177",
            "telephone_number": "949-637-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31726 RANCHO VIEJO RD STE 103",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752723",
            "telephone_number": "949-493-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHATIBLOU",
        "first_name": "NAZ",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-10",
        "last_updated": "2020-10-10",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in San Juan Capistrano, CA
• Providers in San Juan Capistrano, 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 Oct 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.