KHALED EISSA DDS INC - NPI NUMBER 1952745895

Summary

Provider Name: KHALED EISSA DDS INC

NPI Number: 1952745895

Clasification: Dentist (122300000X)

Address:
31737 RIVERSIDE DR STE B
LAKE ELSINORE, CA
ZIP 92530

Phone Number: (951) 674-8707



Detailed Information

KHALED EISSA DDS INC is a dentist in Lake Elsinore, CA. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. The assigned NPI number for this provider is 1952745895 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

31737 RIVERSIDE DR STE B
LAKE ELSINORE, CA
ZIP 92530-890
Phone: (951) 674-8707

The provider's authorized official is Khaled Eissa .
The authorized official title is C.e.o. and has the following contact phone number (763) 587-8345.

The enumeration date for this NPI number is 4/22/2013 and was last updated on 4/22/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 122300000X Dentist 59237 CA Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1952745895 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name KHALED EISSA DDS INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 31737 RIVERSIDE DR STE B The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name LAKE ELSINORE The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 925307890 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 9516748707 The telephone number associated with the location address of the provider being identified.
11 Provider Enumeration Date 4/22/2013 The date the provider was assigned a unique identifier (assigned an NPI).
12 Last Update Date 4/22/2013 The date that a record was last updated or changed.
13 Authorized Official Last Name EISSA The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
14 Authorized Official First Name KHALED The first name of the authorized official.
15 Authorized Official Title or Position C.E.O. The title or position of the authorized official.
16 Authorized Official Telephone Number 7635878345 The 10-position telephone number of the authorized official.
17 Healthcare Provider Taxonomy Code 1 122300000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
18 Provider License Number 1 59237 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
19 Provider License Number State Code 1 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart N
22 Authorized Official Name Prefix Text DR.
23 Authorized Official Credential Text DDS
24 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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