Active NPI
Wali Khan, DDS
- General Practice Dentistry
- Bronx, NY
National Provider Identifier
1952467334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 045003
- Practice address
- 1221 White Plains Rd
Suite 106
Bronx, NY 10472-4937 - Phone
- (718) 792-6991
- Fax
- (718) 792-0654
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 045003 | NY | Primary |
Addresses
Primary practice location
1221 White Plains Rd
Suite 106
Bronx, NY 10472-4937
Mailing address
3733 77TH St
Jackson Heights, NY 11372-6629
Phone (718) 478-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01471549 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- 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 |
|---|---|---|---|---|
| I20160425001271 | NY | Order and Referring Only - Oral Surgery | 5193024230 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1952467334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3733 77TH ST",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113726629",
"telephone_number": "718-478-6100",
"fax_number": "718-476-9454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 WHITE PLAINS RD",
"address_2": "SUITE 106",
"city": "BRONX",
"state": "NY",
"postal_code": "104724937",
"telephone_number": "718-792-6991",
"fax_number": "718-792-0654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "WALI",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "045003",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01471549",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.