Michael Khadavi, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

111343 Issued in NY

Practice address

935 Northern Blvd
Ste 104
Great Neck, NY 11021

Phone

(516) 487-0155

Fax

(516) 487-8390

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982612883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 NORTHERN BLVD",
            "address_2": "STE 104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-487-0155",
            "fax_number": "516-487-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 NORTHERN BLVD",
            "address_2": "STE 104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-487-0155",
            "fax_number": "516-487-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADAVI",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "111343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Kern, DDS
• Steven Jay Kerpen, D.M.D.
• Ryan Kershis, DPT
• Edmund Kessler, M.D.
• Martin E. Kessler, M.D.,F.A.C.S.
• Boris Khaimov, D.O,
• Azam Zari Khaledi, D.M.D
• Ayesha Khalid, MD
• Dvora Khalili
• Deborah Khalou, PHARM.D.

• Pediatrics Physician in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.