Kerolos George Khalil, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109082 Issued in CA

Practice address

2288 Daniels St
Manteca, CA 95337-6706

Phone

(209) 456-5610

NPI assigned

Jul 13, 2023

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

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

Practice roles

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.

• Robert P. Nakaki Dental Corporation

  dba Stadium Dental Group

  • General Practice Dentistry
  • Manteca, CA
  • NPI 1841471299
  NPD (past)

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

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1942989280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 JENNI LN",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953779592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2288 DANIELS ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953376706",
            "telephone_number": "209-456-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "KEROLOS",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-13",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Kellstrom, LMFT
• Kelly Mah, M.D. (Manteca Obstetrics and Gynecology Medical Group)
• Himaja Kenchey
• Kenneth S. Ching, MD., Inc
• El Rasheed Khalifa, DDS
• Abdul Waheed Khan, M.D.
• Ghazala Rahman Khan, DDS
• Shandana Khan
• Maryam Khatami
• Balwinder Singh Khosa

• General Practice Dentistry in Manteca, CA
• Providers in Manteca, 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 Sep 5, 2023; 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.