Khosrow Benjamin Azizi, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DS025908L Issued in PA

Practice address

242 N Keswick Ave
Glenside, PA 19038-4804

Phone

(215) 576-6414

Fax

(215) 576-8497

NPI assigned

Jan 12, 2007

Last updated

Dec 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Benjamin K Azizi Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Benjamin K Azizi

  • Dental Clinic/Center
  • Glenside, PA
  • NPI 1427695931
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1881744563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-576-6414",
            "fax_number": "215-576-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-576-6414",
            "fax_number": "215-576-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZIZI",
        "first_name": "KHOSROW",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS025908L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BENJAMIN",
            "last_name": "AZIZI",
            "middle_name": "K",
            "prefix": "DR.",
            "credential": "D.M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Glenside, PA
• Providers in Glenside, PA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.