Active NPI
Ida Khobahy, DDS
- Dentist
- Cornelius, OR
National Provider Identifier
1972941201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10260
- Practice address
- 44 N 11TH Ave
Cornelius, OR 97113-9020 - Phone
- (503) 359-8505
- Fax
- (503) 359-8535
- NPI assigned
- Jun 9, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D10260 | OR | Primary |
Addresses
Primary practice location
44 N 11TH Ave
Cornelius, OR 97113-9020
Mailing address
PO Box 568
Cornelius, OR 97113-0568
Phone (503) 352-8657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20151215002779 | OR | Order and Referring Only - Oral Surgery | 8820399975 |
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": "1370736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1972941201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 568",
"city": "CORNELIUS",
"state": "OR",
"postal_code": "971130568",
"telephone_number": "503-352-8657",
"fax_number": "503-352-8658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 N 11TH AVE",
"city": "CORNELIUS",
"state": "OR",
"postal_code": "971139020",
"telephone_number": "503-359-8505",
"fax_number": "503-359-8535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOBAHY",
"first_name": "IDA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-09",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cornelius, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.