Healthcare Provider Details

I. General information

NPI: 1205049707
Provider Name (Legal Business Name): YATIN KHANNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

1 RIVER CT APARTMENT 2206
JERSEY CITY NJ
07310-2001
US

V. Phone/Fax

Practice location:
  • Phone: 718-915-3713
  • Fax: 866-894-5881
Mailing address:
  • Phone: 718-915-3713
  • Fax: 866-894-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number053649
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI02350900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: