Khorsandi, Jan A
Khorsandi, Jan A is an individual health care provider with primary practice located at 1874 Clove Rd , Staten Island NY 10304-1637. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Khorsandi, Jan A can be contacted via phone (718) 273-0212.Contact Information
Primary practice address
1874 Clove Rd
Staten Island NY 10304-1637
Phone: (718) 273-0212
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 051098L | New York |
Profile Details
| NPI number | 1619951647 |
|---|---|
| LBN Legal business name | Khorsandi, Jan A |
| Credentials | DMD PC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 2nd, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619951647 | NPPES |
| New York | MEDICAID | 02617999 |
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