Active NPI
Mary-Ann Ibrahim Khamis, D.D.S.
- Dentist
- Fountain Valley, CA
National Provider Identifier
1861827198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62884
- Practice address
- 9919 Merced River Avenue
Fountain Valley, CA 92708 - Phone
- (714) 906-9951
- NPI assigned
- Sep 5, 2013
- Last updated
- Sep 5, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | 62884 | CA | Primary |
Addresses
Primary practice location
9919 Merced River Avenue
Fountain Valley, CA 92708
Mailing address
9919 Merced River Ave
Fountain Valley, CA 92708-2923
Phone (714) 906-9951
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150903000985 | CA | Order and Referring Only - Dentist | 8820304967 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62884 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1861827198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9919 MERCED RIVER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082923",
"telephone_number": "714-906-9951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9919 MERCED RIVER AVENUE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "92708",
"telephone_number": "714-906-9951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAMIS",
"first_name": "MARY-ANN",
"middle_name": "IBRAHIM",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-05",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
- Laura Ketcham, BA
- Keun-Heng Huo, MD, Inc.
- Kevin Khai Tieu M D a Professional Corporation (Kevin Khai Tieu, MD PC)
- Kevin Kieu DDS,Ms,Inc.
- Khai T Vu MD Medical Corporation (New Hope Hematology Oncology Consultants, Inc)
- Angela Khampha
- Ahad U. Khan, NP-C
- Jawad Khan, M.D.
- Tony Khan, DO
- Zafar Saleem Khan, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; 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.