Individual provider Active NPI

Emmanuel B. Kandkhorov, DDS

  • Dentist
  • Irvine, CA
National Provider Identifier
1902933831
Registry record updated Jan 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
50617 Issued in CA
Practice address
33 Creek Rd Ste a-150
Irvine, CA 92604-4791
Phone
(949) 825-7799
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 50617 CA Primary

Addresses

Primary practice location

33 Creek Rd Ste a-150
Irvine, CA 92604-4791

Mailing address

33 Creek Rd Ste a-150
Irvine, CA 92604-4791
Phone (949) 825-7799

Other identifiers 1

IdentifierTypeStateIssuer
9180098OtherCADORAL

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors Preferred Home Health Care Inc. CurrentSince Jan 22, 2019 Accepting new patients
MD Choice Hospice Care Inc. CurrentSince Jan 22, 2019 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515369600000",
    "number": "1902933831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 CREEK RD STE A-150",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044791",
            "telephone_number": "949-825-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 CREEK RD STE A-150",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044791",
            "telephone_number": "949-825-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDKHOROV",
        "first_name": "EMMANUEL",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2018-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "9180098",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; 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.