Healthcare Provider Details

I. General information

NPI: 1033963038
Provider Name (Legal Business Name): MATTHEW KHANYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 CLINTON ST
HEMPSTEAD NY
11550-4211
US

IV. Provider business mailing address

5645 MAIN ST
FLUSHING NY
11355-5045
US

V. Phone/Fax

Practice location:
  • Phone: 516-538-8980
  • Fax:
Mailing address:
  • Phone: 718-670-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: