Koorosh Shamtoub DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

051063 Issued in NY

Legal business name

KOOROSH SHAMTOUB DDS PC

Practice address

9413 Flatlands Ave Ste 102W
Brooklyn, NY 11236-3713

Phone

(718) 257-0300

Fax

(718) 257-0670

NPI assigned

Sep 7, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Koorosh Shamtoub, DDSNPI 1205819919

Title

Ceo

Phone

(718) 257-0300

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Koorosh Shamtoub, DDS

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1205819919
  NPD (past) Authorized official

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

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315353600000",
    "number": "1962783779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9413 FLATLANDS AVE STE 102W",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363713",
            "telephone_number": "718-257-0300",
            "fax_number": "718-257-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9413 FLATLANDS AVE STE 102W",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363713",
            "telephone_number": "718-257-0300",
            "fax_number": "718-257-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOROSH SHAMTOUB DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-07",
        "last_updated": "2011-09-07",
        "status": "A",
        "authorized_official_last_name": "SHAMTOUB",
        "authorized_official_first_name": "KOOROSH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-257-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "051063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02496220",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor McKinley Koonce
• Mitchell David Koonin, DDS
• Jennifer Elaine Koonings, PMHNP
• Leesha Koonjoo
• Koorga LLC
• Justin James Kopa, M.D.
• Ilya Kopach, FNP
• Nikolay Kopach, LAC
• Peter Kopach, L.A.C
• Mariana Kopachevska

• Dentist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.