NPIMap

Organization Active NPI

Khaled Eissa DDS Inc

  • Dentist
  • Lake Elsinore, CA
National Provider Identifier
1952745895
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
59237 Issued in CA
Legal business name
KHALED EISSA DDS INC
Practice address
31737 Riverside Dr Ste B
Lake Elsinore, CA 92530-7890
Phone
(951) 674-8707
NPI assigned
Apr 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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

Authorized official

Name
Dr. Khaled Eissa, DDSNPI 1407903776
Title
C.E.O.
Phone
(763) 587-8345

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 59237 CA Primary

Addresses

Primary practice location

31737 Riverside Dr Ste B
Lake Elsinore, CA 92530-7890

Mailing address

1935 Dainty Way
Hemet, CA 92545-8960
Phone (763) 587-8345

National Provider Directory

National Provider Directory

Locations

31737 Riverside Dr
Ste B
Lake Elsinore, CA 92530
Phone (951) 674-8707

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1952745895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 DAINTY WAY",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925458960",
            "telephone_number": "763-587-8345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31737 RIVERSIDE DR STE B",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925307890",
            "telephone_number": "951-674-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHALED EISSA DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-22",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "EISSA",
        "authorized_official_first_name": "KHALED",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "763-587-8345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "59237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.